22632 prior authorization | Premera Blue Cross of Washington
22632, Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 22632
- Description
- Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace These criteria do not imply or guarantee approval.
- Source
- Clinical Review by Code List PBCWA, Pg 258 Original policy