22630 prior authorization | Premera Blue Cross of Washington

22630, Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 22630
Description: Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar
Source: Clinical Review by Code List PBCWA, Pg 258 Original policy

Premera Blue Cross of Washington prior authorization

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