CPT 22842 · Other Procedure · Aetna
Posterior Segmental Instrumentation — 3-6 Segments at Aetna.
How Aetna approaches CPT 22842 (Posterior Segmental Instrumentation — 3-6 Segments) 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 22842. 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.
See the full Aetna criteria.
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