CPT 22630 · Other Procedure · BCBS Alabama
Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF) at BCBS Alabama.
How BCBS Alabama approaches CPT 22630 (Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF)) for prior-authorization review: at last review on 2026-03-15, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-03-15
Criteria summary
High-level themes from the BCBS Alabama policy of record for CPT 22630. 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.
See the full BCBS Alabama criteria.
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