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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · Orthopedics, NeurosurgeryMedium impact

Axial Lumbosacral Interbody Fusion

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Axial lumbosacral interbody fusion, which gives anterior access to the L4-S1 disc spaces, is considered investigational under this BCBS policy. FDA-cleared anterior spinal intervertebral body fixation systems are limited to anterior supplemental fixation of the lumbar spine at L5-S1 or L4-S1, used with legally marketed facet or pedicle screw systems. These systems are not intended to treat severe scoliosis, grade 3 or 4 spondylolisthesis, tumor, trauma, vertebral compression fractures, or any condition that compromises the mechanical integrity of the vertebral body. The policy was last reviewed 09/09/2026 with no changes.

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What to do

Action · 4 steps
01Billing team: Before billing axial lumbosacral interbody fusion, check the member's specific benefit plan language, because the Medical Policy Manual guidelines should not be used in place of it.
02Under this policy the procedure is investigational, which the policy defines as not yet a generally accepted standard of good medical practice and therefore not considered medically necessary.
03For Federal Employee Program members, FDA-approved devices may be assessed only on the basis of medical necessity.
04Confirm that any fixation device used is one of the FDA-cleared systems and is used only for anterior supplemental fixation at L5-S1 or L4-S1 with legally marketed facet or pedicle screws.

Codes mentioned

22586

Original notice

Axial Lumbosacral Interbody Fusion
bcbsms.com · Always check the source before changing claims.
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Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOrthopedicsNeurosurgeryCode 22586

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