22633 prior authorization | Premera Blue Cross of Washington

22633, Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 22633
Description: Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar
Source: Clinical Review by Code List PBCWA, Pg 259 Original policy

Premera Blue Cross of Washington prior authorization

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