CPT 22633 · Other Procedure · Aetna
Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar at Aetna.
How Aetna approaches CPT 22633 (Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar) for prior-authorization review: at last review on 2025-09-12, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-09-12
Policy number
CPB-0743Criteria summary
High-level themes from the Aetna policy of record for CPT 22633. 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: Aetna Clinical Policy Bulletin 0743 — Spinal Surgery: Lumbar Spinal Fusion
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