CPT 22857 · Spine Surgery · UnitedHealthcare (Commercial)
Total Disc Arthroplasty — Lumbar (1 level) at UnitedHealthcare (Commercial).
How UnitedHealthcare (Commercial) approaches CPT 22857 (Total Disc Arthroplasty — Lumbar (1 level)) for prior-authorization review: at last review on 2025-10-01, the policy does not cover this code with prior authorization required.
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UHC-MP-LUMBAR-TDRCriteria summary
High-level themes from the UnitedHealthcare (Commercial) 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: UnitedHealthcare Commercial Medical Policy — Lumbar Disc Arthroplasty
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