CPT 22633 · Other Procedure · Humana
Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar at Humana.
How Humana approaches CPT 22633 (Arthrodesis, Combined Posterior + Posterior Interbody — Lumbar) for prior-authorization review: at last review on 2025-12-22, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-12-22
Policy number
Spine Surgery (HUM-2235-000)Criteria summary
High-level themes from the Humana policy of record for CPT 22633. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Humana Medical Coverage Policy — Spine Surgery (Spinal Fusion Surgery)
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