CPT 22857 · Disc Arthroplasty
Total Disc Arthroplasty — Lumbar (1 level)
Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar. Frequently denied as investigational.
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Rubrica tracks payor coverage for CPT 22857 (Total Disc Arthroplasty — Lumbar (1 level)) across 11 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 22857
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 Medicare Advantage | Covered | Prior auth |
| Anthem BCBS | Covered | No PA |
| BCBS Illinois | Covered | No PA |
| BCBS Texas | Covered | No PA |
| Cigna Medicare / HealthSpring | Covered | Prior auth |
| Highmark BCBS | Covered | No PA |
| Humana Medicare Advantage | Covered | Prior auth |
| Molina Healthcare (Medicaid) | Covered | Prior auth |
| Railroad Medicare (Palmetto GBA national) | Covered | Prior auth |
| UnitedHealthcare (Commercial) | Covered | No PA |
| UnitedHealthcare Medicare Advantage | Covered | Prior auth |
Coverage themes for CPT 22857
Common patterns across the 11 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥24 weeks of conservative care before approving 22857.
5 of 11 payors require imaging concordance documentation.
Of the 11 payors with coverage records for CPT 22857, 8 require prior authorization, 0 cover without prior authorization, and 5 flag the procedure as investigational or experimental under current criteria.
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