CPT 22867 · Interspinous device · Premera Blue Cross
Vertiflex — Interspinous Process Decompression (1st level) at Premera Blue Cross.
How Premera Blue Cross approaches CPT 22867 (Vertiflex — Interspinous Process Decompression (1st level)) for prior-authorization review: at last review on 2025-01-01, the policy does not cover this code with prior authorization required.
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7.01.107Criteria summary
High-level themes from the Premera Blue Cross policy of record for CPT 22867. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Premera Medical Policy 7.01.107 — Interspinous and Interlaminar Stabilization/Distraction Devices
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