MedicaidPrior AuthMedium impact
BT202171: IHCP updates cervical arthroplasty PA criteria
Indiana Medicaid (IHCP)·IN · Orthopedics, Neurosurgery·Provider Bulletin
Effective date
Sep 17, 2021
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) updated prior authorization criteria for cervical arthroplasty (CPT 22856) effective September 17, 2021. The procedure now requires compliance with nationally recognized care guidelines plus specific MRI/CT imaging requirements and absence of cervical instability confirmed by X-ray measurements.
Action Required
By September 17, 2021: Billing team must update prior authorization requirements for CPT 22856 to include nationally recognized care guidelines compliance, MRI/CT imaging confirmation of compression, and X-ray documentation showing no cervical instability (less than 11 degrees angulation and less than 3mm translation). Update encounter forms to remind providers of new imaging requirements. Contact Gainwell Technologies at 800-457-4584 option 7 for FFS PA questions or relevant MCE for managed care patients.