CPT 22630 · Spine Surgery · BCBS Texas
Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF) at BCBS Texas.
How BCBS Texas approaches CPT 22630 (Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF)) for prior-authorization review: at last review on 2025-09-01, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-09-01
Policy number
BCBSTX-MP-22630Criteria summary
High-level themes from the BCBS Texas 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.
Source: Blue Cross Blue Shield of Texas medical policy — Spine Surgery
See the full BCBS Texas criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →