CPT 22869 · Interspinous Device · Devoted Health
Vertiflex — Interspinous (1st level, no decompression) at Devoted Health.
How Devoted Health approaches CPT 22869 (Vertiflex — Interspinous (1st level, no decompression)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Clearway-MPG-MinuteMan_InspanCriteria summary
High-level themes from the Devoted Health policy of record for CPT 22869. 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: Clearway Master Payer Guidelines v2025 — MinuteMan_Inspan
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