CPT 22612 · Other Procedure · Cigna
Arthrodesis, Posterior — Lumbar (PLF) at Cigna.
How Cigna approaches CPT 22612 (Arthrodesis, Posterior — Lumbar (PLF)) for prior-authorization review: at last review on 2025-09-15, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-09-15
Policy number
Cigna 0303 / eviCore SpineCriteria summary
High-level themes from the Cigna policy of record for CPT 22612. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Cigna criteria.
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