CPT 22868 · Interspinous Device · Priority Partners MCO
Vertiflex — Interspinous (add'l level) at Priority Partners MCO.
How Priority Partners MCO approaches CPT 22868 (Vertiflex — Interspinous (add'l level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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eviCore CMM-608Criteria summary
High-level themes from the Priority Partners MCO policy of record for CPT 22868. 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: JHHC / eviCore CMM-608 — Spine Surgery (Priority Partners)
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