Home
Billing codes
22212

PAYER POLICY CHANGES

22212 Insurance Policy Changes

CPT 22212, in plain terms, covers Osteotomy of the thoracic spine through a back or back-and-side approach, cutting and realigning bone at one vertebral segment. CPT 22212 is referenced in 5 tracked payer policy changes from Capital Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 22212 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 22212 on AAPC

Capital Blue Cross · Effective Mar 1, 2026High impact
AB2026-01-001 Updates and new information
Effective March 1, 2026, a number of codes newly require preauthorization for Commercial and Medicare Advantage members, including 20985, 22100 and 27860, and HCPCS code H0032 will be denied because the service is not provided directly to members. Codes C1605, C1721 and others no longer require preauthorization effective February 1, 2026, Evolent updated its CT, MRI, PET and cardiac imaging policies effective March 1, 2026, and TurningPoint accepts listed substitute codes for a limited group of musculoskeletal surgical procedures effective February 1, 2026. Effective for claims processed on or after March 1, 2026, facility claims with modifiers 59, XE, XP, XS and XU that do not meet the CMS criteria to bypass an NCCI procedure-to-procedure edit will be rejected, and physical medicine code 97140 is not separately reimbursed when billed with chiropractic manipulative treatment in the same anatomical region.
Aetna · Identified Jun 19, 2026High impact
OfficeLink Updates - April 2026 notices and reminders (PDF)
This April 2026 notice covers several changes that have all passed their stated dates. Effective March 1, 2026, Remote Physiologic Monitoring (CPT 99453-99458) is covered only for heart failure, hypertension or diabetes, with an FDA-approved or FDA-cleared device that transmits data automatically, data used to adjust treatment, and documented member consent. Effective April 1, 2026, laminectomy codes performed as part of the access for spinal osteotomy codes 22212 and 22214 are not reimbursed separately on the same date of service. Effective July 1, 2026, reconstructive codes 15733-15738 and 14000-14302 are denied as incidental when billed on the same date of service as breast surgery (19300-19396) or digestive system surgery (40490-49999) codes by different providers. Commercial drug lists and the Combined Benefit Management drug list were updated on July 1, 2026, and several drugs were added to precertification lists with dates from March 1, 2026 through July 1, 2026.
Humana · Effective Aug 5, 2026Medium impact
Spinal Fusion and Stabilization Surgery - MEDICAID - KENTUCKY (New)
Humana's Kentucky Medicaid medical coverage policy HUM-KY-2235-000 for spinal fusion and stabilization surgery has an effective date of August 5, 2026. Humana Medicaid members may be eligible for corpectomy, kyphectomy, lumbar artificial disc replacement, sacroiliac joint fusion, spinal fusion and spinal osteotomy when the policy criteria are met, and prior authorization is required for the services addressed in the policy.
Aetna · Identified Oct 3, 2026Medium impact
Idiopathic Scoliosis (CPB 0398, reviewed 2026-09-28)
Aetna considers spinal fusion with instrumentation and bone grafting medically necessary for idiopathic scoliosis with a curve of 40 degrees or greater in an adolescent younger than 18, or a curve of 50 degrees or greater in a young adult aged 18 to 25. Lumbar vertebral body tethering is considered medically necessary for skeletally immature members with lumbar idiopathic scoliosis whose lumbar curve is between 40 and 65 degrees, whose curve reduces by 50 percent or more on side-bending radiographs, and who have no sagittal imbalance, while vertebral body tethering for thoracic scoliosis is listed as experimental, investigational or unproven. Braces are considered medically necessary when the Boston, Charleston, Milwaukee, Providence, Rigo-Cheneau, standard TLSO and other listed types are prescribed by a qualified practitioner and furnished by a licensed or certified orthotist or prosthetist within six months of the prescription, while the Copes, SpineCor, Rosenberger, ScoliBrace, UNYQ and Whisper braces are considered experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Idiopathic Scoliosis (CPB 0398, reviewed 2026-01-15)
Aetna considers spinal fusion with instrumentation and bone grafting medically necessary for idiopathic scoliosis with a curve of 40 degrees or greater in an adolescent younger than 18, or a curve of 50 degrees or greater in a young adult aged 18 to 25. Lumbar vertebral body tethering is considered medically necessary for skeletally immature members with a lumbar idiopathic scoliosis curve between 40 and 65 degrees that is flexible with at least 50% reduction on side-bending radiographs and no sagittal imbalance, and the MAGEC System and Shilla growth guidance technique are considered medically necessary growing rods for members who meet the surgery criteria. The policy lists the Boston, Charleston, Milwaukee, Peak Scoliosis Bracing System, Providence, Rigo-Cheneau, Risser jacket, standard TLSO and TechnoSpine TLSO-Scoliosis Brace as medically necessary durable medical equipment, and it considers the Copes, SpineCor, ScoliBrace, UNYQ, Whisper and Rosenberger braces, the Schroth method, vertebral body stapling, ApiFix, genetic testing such as ScoliScore, and other listed methods experimental, investigational or unproven.

Watch 22212

Get one email when a payer policy names 22212, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules16

Payers requiring prior auth16

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
BCBS Michigan · Effective October 13, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 22212?

Aetna lists 22212 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for 22212?

Ambetter lists 22212 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 22212?

Anthem BCBS lists 22212 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 22212?

Arizona Complete Health lists 22212 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 22212?

BCBS Illinois lists 22212 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 22212?

There are 5 tracked policy changes affecting CPT 22212, including updates from Capital Blue Cross, Aetna, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 22212?

Payers that have issued tracked updates for CPT 22212 include: Capital Blue Cross, Aetna, Humana.

How do I get notified when CPT 22212 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 22212. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 22212?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 22212

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 22212 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

AB2026-01-001 Updates and new information

OfficeLink Updates - April 2026 notices and reminders (PDF)

Spinal Fusion and Stabilization Surgery - MEDICAID - KENTUCKY (New)

Idiopathic Scoliosis (CPB 0398, reviewed 2026-09-28)

Idiopathic Scoliosis (CPB 0398, reviewed 2026-01-15)

Prior authorization required