22870 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

22870, Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 22870
Description: Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 96 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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