22853 prior authorization | Blue Cross and Blue Shield of Montana
22853, Insertion Of Interbody Biomechanical Device(S) (Eg Synthetic Cage Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg Screws Flanges) When Performed To Intervertebral Disc Space In Conjunction With Interbody Arthrodesis Each Interspace (List Separately In Addition To Code For Primary Procedure), is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.
- Code
- 22853
- Description
- Insertion Of Interbody Biomechanical Device(S) (Eg Synthetic Cage Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg Screws Flanges) When Performed To Intervertebral Disc Space In Conjunction With Interbody Arthrodesis Each Interspace (List Separately In Addition To Code For Primary Procedure)
- Source
- 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 26 Original policy