22857 prior authorization | Blue Cross and Blue Shield of Montana

22857, Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Single Interspace Lumbar, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 22857
Description: Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Single Interspace Lumbar
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 29 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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