CPT 22842 · Other Procedure · Tricare
Posterior Segmental Instrumentation — 3-6 Segments at Tricare.
How Tricare approaches CPT 22842 (Posterior Segmental Instrumentation — 3-6 Segments) for prior-authorization review: at last review on 2026-04-15, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-15
Criteria summary
High-level themes from the Tricare 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.
Source: TRICARE Policy Manual 6010.60-M, Chapter 4 — Surgical Services
See the full Tricare criteria.
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