Home
Billing codes
22862

PAYER POLICY CHANGES

22862 Insurance Policy Changes

CPT 22862, in plain terms, covers Surgeon revises or replaces a previously implanted artificial disc prosthesis at a single lumbar level, including removal of the old device. CPT 22862 is referenced in 9 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Rhode Island, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 22862 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 22862 on AAPC

Excellus BlueCross BlueShield · Effective Jan 1, 2027Medium impact
Spine Procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.126
Excellus BlueCross BlueShield policy 7.01.126 sets medical necessity criteria for spine procedures for Managed Medicaid, Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) members, with a current effective date of January 1, 2027. It covers cervical arthrodesis, corpectomy, disc arthroplasty, anterior and posterior cervical decompression, lumbar arthrodesis, lumbar decompression, lumbar discectomy, lumbar osteotomy and pediatric scoliosis surgery, and it considers percutaneous lumbar disc decompression and discectomy investigational. A policy edit dated 10/15/26 removed all site-of-care criteria and smoking-status criteria from lumbar decompression requirements.
Blue Cross Blue Shield of Rhode Island · Effective Nov 1, 2025High impact
Prior Authorization of Spinal Procedures
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.
Blue Cross Blue Shield of Rhode Island · Effective Oct 1, 2025High impact
Medical policy updates
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 · Effective Oct 15, 2026Medium impact
Artificial Lumbar Intervertebral Disc - (Effective Date - 2026-10-15) 7.01.63
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.
Regence BlueShield · Effective Oct 1, 2026Medium impact
Artificial Intervertebral Disc
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.
Regence BlueShield · Effective Oct 1, 2026Medium impact
Artificial Intervertebral Discs
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 · 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.
Humana · Effective Apr 1, 2026Medium impact
Artificial Intervertebral Disc Replacement - Medicare Advantage (Revised)
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Artificial Intervertebral Disc: Lumbar Spine
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.

Watch 22862

Get one email when a payer policy names 22862, 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 rules22

Payers requiring prior auth22

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 22862?

Aetna lists 22862 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 22862?

Ambetter lists 22862 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 22862?

Anthem BCBS lists 22862 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 22862?

Arizona Complete Health lists 22862 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 22862?

BCBS Arizona lists 22862 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 22862?

There are 9 tracked policy changes affecting CPT 22862, including updates from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Rhode Island, Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 22862?

Payers that have issued tracked updates for CPT 22862 include: Excellus BlueCross BlueShield, Blue Cross Blue Shield of Rhode Island, Regence BlueShield, Humana, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 22862 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 22862. 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 22862?

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 22862

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 22862 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

Spine Procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.126

Prior Authorization of Spinal Procedures

Medical policy updates

Artificial Lumbar Intervertebral Disc - (Effective Date - 2026-10-15) 7.01.63

Artificial Intervertebral Disc

Artificial Intervertebral Discs

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

Artificial Intervertebral Disc Replacement - Medicare Advantage (Revised)

Artificial Intervertebral Disc: Lumbar Spine

Prior authorization required