22614 prior authorization | Premera Blue Cross of Washington

22614, Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 22614
Description: Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)
Source: Clinical Review by Code List PBCWA, Pg 258 Original policy

Premera Blue Cross of Washington prior authorization

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