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22838

PAYER POLICY CHANGES

22838 Insurance Policy Changes

CPT 22838, in plain terms, covers The surgeon goes back in to adjust, swap out, or take out a thoracic vertebral body tether placed earlier for scoliosis, and a scope in the chest may be used to do it. CPT 22838 is referenced in 8 tracked payer policy changes from Humana, Capital Blue Cross, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 22838 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 22838 on AAPC

Humana · Effective Sep 1, 2026High impact
Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)
Effective September 1, 2026, Humana Medicare Advantage will NOT cover Dynamic Spinal Stabilization (DSS) procedures or Vertebral Body Tethering (VBT) procedures for any indication. All claims for these procedures using the listed CPT and Category III codes will be denied as not medically reasonable and necessary. The policy cites insufficient evidence and lack of long-term outcome data to support coverage.
Capital Blue Cross · Effective Apr 1, 2026High impact
AB2026-02-001 Updates and new information
Capital Blue Cross planned an electronic-only appeals and medical records process through Availity Essentials, but the rollout was postponed, with details to follow in the March Provider Bulletin, and the earlier schedule had required appeals to be submitted electronically beginning April 1, 2026. Effective for claims processed on or after April 1, 2026, Capital requires an anatomical modifier on radiology procedures that need one and will deny claims for incorrect coding when it is missing, and it will deny recovery room services (revenue code 0710) billed without anesthesia services (revenue code 037x) on the same date of service. Effective April 1, 2026, Capital also stops paying critical care services (CPT 99291 and 99292) on emergency department outpatient claims when the patient is discharged home during the same encounter, and it stops separately paying code 69209 for Commercial and CHIP members.
UnitedHealthcare · Effective Apr 1, 2026High impact
Updated prior authorization codes for VBT services
UnitedHealthcare has added six new vertebral body tethering (VBT) codes to their prior authorization requirements effective April 1, 2026. All VBT procedures using these codes now require prior authorization approval before services are rendered.
Humana · Effective Oct 1, 2025High impact
Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)
Humana Medicare Advantage will not cover Dynamic Spinal Stabilization or Vertebral Body Tethering procedures effective October 1, 2025, deeming them not medically reasonable and necessary. All related CPT codes will be denied for Medicare Advantage patients.
UnitedHealthcare · Effective Sep 1, 2026Medium impact
Medicaid: New prior authorization codes for VBT and extremity prosthetics services
Starting September 1, 2026, UnitedHealthcare will require prior authorization for vertebral body tethering (VBT) codes and upper/lower extremity prosthetics codes across multiple state Medicaid plans. The VBT codes were previously classified as unproven but are now considered proven in certain clinical circumstances, while the prosthetics codes are newly established AMA codes.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Interventions for Progressive Scoliosis
A rigid cervical-thoracic-lumbar-sacral or thoracic-lumbar-sacral orthosis (brace) may be considered medically necessary for scoliosis in juvenile and adolescent individuals at high risk of progression who meet the listed criteria. Vertebral body stapling and vertebral body tethering for scoliosis are considered investigational. The most recent update dated 10/14/2026 updated the policy description regarding vertebral body tethering and updated the first medically necessary policy statement for clarity.

Watch 22838

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REFERENCE DATA

Payers with rules14

Payers requiring prior auth14

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
BCBS Arizona · Effective October 1, 2026
Prior authorization required
AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026)
Excellus BlueCross BlueShield · Effective October 1, 2026
Prior authorization required
Excellus BCBS utilization management standard clinical review preauthorization list

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 22838?

Aetna lists 22838 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 22838?

Ambetter lists 22838 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 22838?

Anthem BCBS lists 22838 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 22838?

Arizona Complete Health lists 22838 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 Arizona require prior authorization for 22838?

BCBS Arizona lists 22838 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 22838?

There are 8 tracked policy changes affecting CPT 22838, including updates from Humana, Capital Blue Cross, UnitedHealthcare. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 22838?

Payers that have issued tracked updates for CPT 22838 include: Humana, Capital Blue Cross, UnitedHealthcare, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 22838 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 22838. 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 22838?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 22838 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)

AB2026-02-001 Updates and new information

Updated prior authorization codes for VBT services

Dynamic Spinal Stabilization and Vertebral Body Tethering for Spinal Deformities - Medicare Advantage (Revised)

Medicaid: New prior authorization codes for VBT and extremity prosthetics services

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

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

Interventions for Progressive Scoliosis

Prior authorization required

Prior authorization required

Prior authorization required

Does Aetna require prior authorization for 22838?

Does Ambetter require prior authorization for 22838?

Does Anthem BCBS require prior authorization for 22838?

Does Arizona Complete Health require prior authorization for 22838?

Does BCBS Arizona require prior authorization for 22838?

What insurance policy changes affect CPT 22838?

Which payers have updated policy for CPT 22838?

How do I get notified when CPT 22838 policy changes?

Why do payers change policies for CPT 22838?