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

By 08/05/2026: Billing team must implement prior authorization requirements for all spinal procedures covered under this policy. (1) Update billing system to require prior authorization for CPT codes 63081-63091, 63101-63103, 63300-63308 (corpectomy), 22818-22819 (kyphectomy), and 22857, 22860 (lumbar disc replacement). (2) Create clinical criteria verification checklist for providers to document: diagnostic imaging confirmation, specific medical condition (degenerative disc disease, infection, trauma, tumor, etc.), and for kyphectomy—documented functional limitations or deformity progression plus failed conservative treatment documentation. (3) Update prior authorization request forms to require submission of imaging studies and medical documentation meeting specific clinical criteria outlined in policy. (4) Train billing, authorization, and coding staff on new coverage criteria for each procedure type. (5) Communicate policy requirements to all orthopedic and spine surgery providers via written notice and staff education. (6) Configure denial protocols: claims submitted without prior authorization or failing to meet clinical criteria will be denied.