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

Artificial Intervertebral Disc: Cervical Spine

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

Summary

Cervical disc arthroplasty may be considered medically necessary for intractable cervical radicular pain or myelopathy when all listed criteria are met, including an FDA-approved device, skeletal maturity, degenerative disc disease from C3 through C7, degeneration documented by MRI, CT or myelography, and either at least 6 weeks of failed conservative nonoperative treatment (an active pain management program with pharmacotherapy that addresses neuropathic pain and other pain sources, plus physical therapy) or severe or rapidly progressive symptoms requiring hospitalization or immediate surgical treatment. Disc implantation at more than 2 levels and combined use of an artificial cervical disc and fusion are investigational, along with several other listed conditions. The 09/11/2026 policy history entry states that the policy statements were updated with minor changes.

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What to do

Action · 6 steps
01Billing team: Bill CPT 22856 (single interspace), 22858 (second level, listed separately with the primary procedure), 22861 (revision), 22864 (removal), and 0095T and 0098T (additional interspaces, listed separately) only when the chart documents the criteria above.
02For simultaneous implantation at two contiguous levels, the device must be FDA-approved for 2 levels (for example Mobi-C or Prestige LP), and each level must meet all criteria.
03For a subsequent procedure at an adjacent level, the chart must show that the planned procedure is at a different cervical level than the initial implant and must include clinical documentation that the initial implant is fully healed.
04Disc implantation at more than 2 levels and combined use of an artificial disc and fusion are investigational.
05BCBSMS makes no payment for services not documented as medically necessary.
06For Federal Employee Program plans, FEP may dictate that FDA-approved devices may not be considered investigational and may be assessed only on the basis of medical necessity.

Codes mentioned

22856228582286122864

Original notice

Artificial Intervertebral Disc: Cervical Spine
bcbsms.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesOrthopedicsNeurosurgeryCode 22856Code 22858Code 22861Code 22864

Summaries are AI-assisted. Always confirm against the original payer notice.

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