22867 prior authorization | Anthem Blue Cross and Blue Shield Virginia
22867, Insertion of interlaminar/interspinous process stabilization/ distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; sin, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.
- Code
- 22867
- Description
- Insertion of interlaminar/interspinous process stabilization/ distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; sin
- Source
- Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 14 Original policy
Anthem Blue Cross and Blue Shield Virginia prior authorization