CPT 22633 · Other Procedure · BCBS Montana
Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar at BCBS Montana.
How BCBS Montana approaches CPT 22633 (Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar) 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 Montana 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: BCBS Montana Medical Policy SUR707.024 — Spinal Fusion
See the full BCBS Montana criteria.
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