CPT 22860, in plain terms, covers Add-on for total artificial disc replacement at a second lumbar interspace, reported in addition to the primary single-level lumbar disc replacement. CPT 22860 is referenced in 13 tracked payer policy changes from Sentara Health Plans, Humana, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 22860 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 22860 on AAPC
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective October 1, 2026, Sentara Health Plans is implementing multiple coverage and prior authorization changes across Virginia for Commercial, Medicaid, and Medicare products. Key changes include: new prior authorization requirements for common orthopedic procedures (knee/hip arthroplasty, ankle revision), home health nursing services with benefit restrictions, new non-covered services (personal care, habilitation waivers, certain vaccines), and specific oncology lab work requiring OncoHealth contact. Billing teams must immediately update systems to enforce these requirements to avoid claim denials.
Humana Florida Medicaid has issued a new comprehensive coverage policy for spinal fusion and stabilization surgeries effective 09/16/2026. The policy establishes specific medical necessity criteria, approved devices (e.g., iFUSE Implant System for sacroiliac joint fusion, ProDisc L for lumbar disc replacement), and applicable CPT codes for procedures including corpectomy, kyphectomy, lumbar artificial disc replacement, and sacroiliac joint fusion. Billing teams must ensure claims align with documented clinical criteria and use only the specified coding.
This is a new comprehensive Medicaid policy for Indiana covering spinal fusion and stabilization surgeries, including artificial disc replacement, corpectomy, kyphectomy, and sacroiliac joint fusion. The policy establishes specific coverage criteria and includes detailed procedure codes for various spinal surgical procedures effective June 17, 2026.
Effective November 1, 2025, prior authorization requirements for spinal procedures will be expanded to include fully-funded commercial products, with several CPT codes moving between different prior authorization policies. Some codes will have prior auth added while others will have it removed or changed to covered status.
Several prior authorization and coverage changes for Medicare Advantage plans and commercial products took effect October 1, 2025 and November 1, 2025, and both dates are already effective as of the analysis date of 2026-11-05. Some CPT/HCPCS codes changed from requiring prior authorization to being covered, including IMRT and stereotactic body radiation therapy codes. Prior authorization was added for CPT 25447 and for CPT 22585, 22840 and 27280 for Medicare Advantage plans, and it was removed for CPT 63663 and 63664.
Excellus BlueCross BlueShield medical policy 7.01.63 sets the criteria for artificial lumbar intervertebral disc (lumbar total disc arthroplasty), with a current effective date of October 15, 2026. Initial primary surgery is considered medically appropriate for patients aged 18 to 60 with moderate to severe single-level disc degeneration at L3-4, L4-5 or L5-S1 who have had at least six consecutive months of structured non-operative care with less than clinically meaningful improvement. Lumbar total disc arthroplasty is considered not medically necessary for lumbar partial disc prosthetics, as an adjunct to treatment of primary-central or far-lateral disc herniation, for revision of a failed lumbar artificial total disc arthroplasty, and for the other contraindications listed in the policy.
Anterior total cervical disc replacement is considered medically necessary for symptomatic cervical disc degeneration when the policy criteria are met, limited to an FDA-approved disc at one level or two contiguous levels between C3 and C7. Total lumbar disc replacement may be considered medically necessary for single-level symptomatic discogenic low back pain at L3-4, L4-5 or L5-S1 when its criteria are met. Total disc replacement that does not meet the cervical or lumbar criteria is considered not medically necessary, and all other indications are considered investigational.
Single-level cervical disc replacement, or simultaneous replacement at two contiguous cervical levels between C3 and C7, is considered medically necessary when the policy criteria are met for an FDA-approved artificial intervertebral disc in patients who are 18 to 60 years old. Total lumbar disc replacement at L3-4, L4-5 or L5-S1 for symptomatic single-level discogenic low back pain may be considered medically necessary when its criteria are met. All other uses of artificial intervertebral discs, including placement at other spinal levels and cervical placement at more than two levels, are considered investigational.
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.
Humana has updated their South Carolina Medicaid policy for spinal fusion and stabilization surgery, effective June 17, 2026. The policy provides detailed coverage criteria for corpectomy, kyphectomy, lumbar artificial disc replacement, and sacroiliac joint fusion procedures with specific eligibility requirements.
Humana Medicare Advantage has updated their artificial intervertebral disc replacement policy with revised coverage criteria for cervical and lumbar disc replacements. The policy provides detailed medical necessity requirements including age restrictions (≤60 years for lumbar), specific anatomical criteria, and mandatory 6-month conservative treatment failure documentation.
Artificial intervertebral discs of the lumbar spine are considered investigational. Three lumbar artificial disc devices (activL, Charite and ProDisc-L) have FDA premarket approval, but production under the Charite name was stopped in 2010 and the device was withdrawn in 2012. An 08/06/2026 update changed the policy description regarding devices and removed ICD-9 procedure codes from the code reference, with policy statements unchanged.
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