CPT 22633 · Other Procedure · Anthem BCBS
Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar at Anthem BCBS.
How Anthem BCBS approaches CPT 22633 (Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar) for prior-authorization review: at last review on 2026-01-01, the policy covers this code with prior authorization required.
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MSK03-1125.1-UC0126Criteria summary
High-level themes from the Anthem BCBS policy of record for CPT 22633. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Spine Surgery (MSK03-1125.1-UC0126)
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