CPT 22612 · Other Procedure · Medicare (CGS MAC)
Arthrodesis, Posterior — Lumbar (PLF) at Medicare (CGS MAC).
How Medicare (CGS MAC) approaches CPT 22612 (Arthrodesis, Posterior — Lumbar (PLF)) for prior-authorization review: at last review on 2026-05-03, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-03
Criteria summary
High-level themes from the Medicare (CGS MAC) policy of record for CPT 22612. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: CMS IOM 100-08 — Reasonable and Necessary; CGS J15 (no active LCD)
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