CPT 22630 · Spine Surgery · UnitedHealthcare (Commercial)
Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF) at UnitedHealthcare (Commercial).
How UnitedHealthcare (Commercial) approaches CPT 22630 (Arthrodesis, Posterior Interbody — Lumbar (PLIF/TLIF)) for prior-authorization review: at last review on 2025-10-01, the policy covers this code with prior authorization required.
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UHC-MP-SPINE-FUSIONCriteria summary
High-level themes from the UnitedHealthcare (Commercial) 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: UnitedHealthcare Commercial Medical Policy — Spinal Fusion Surgery
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