CPT 22857 · Spine Surgery · BCBS Illinois
Total Disc Arthroplasty — Lumbar (1 level) at BCBS Illinois.
How BCBS Illinois approaches CPT 22857 (Total Disc Arthroplasty — Lumbar (1 level)) for prior-authorization review: at last review on 2025-09-01, the policy does not cover this code with prior authorization required.
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Coverage
Not covered
Prior auth
Prior auth required
InvestigationalInvestigational / experimental
Last reviewed
2025-09-01
Policy number
BCBSIL-MP-22857Criteria summary
High-level themes from the BCBS Illinois policy of record for CPT 22857. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Blue Cross Blue Shield of Illinois medical policy — Spine Surgery
See the full BCBS Illinois criteria.
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