CPT 22842 · Spinal Instrumentation
Posterior Segmental Instrumentation — 3-6 Segments
Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); three to six vertebral segments (list separately in addition to code for primary procedure).
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Rubrica tracks payor coverage for CPT 22842 (Posterior Segmental Instrumentation — 3-6 Segments) across 43 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 22842
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Ambetter | Covered | Prior auth |
| Anthem BCBS | Covered | Prior auth |
| BCBS Alabama | Covered | Prior auth |
| BCBS Federal Employee Program | Covered | Prior auth |
| BCBS Illinois | Covered | Prior auth |
| BCBS Massachusetts | Covered | Prior auth |
| BCBS Michigan | Covered | Prior auth |
| BCBS Montana | Covered | Prior auth |
| BCBS New Mexico | Covered | Prior auth |
| BCBS Oklahoma | Covered | Prior auth |
Coverage themes for CPT 22842
Common patterns across the 43 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥12 weeks of conservative care before approving 22842.
29 of 43 payors require imaging concordance documentation.
Of the 43 payors with coverage records for CPT 22842, 29 require prior authorization, 14 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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