22857 prior authorization | Premera Blue Cross of Washington

22857, Total disc arthroplasty (artificial disc), anterior approach, including 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: 22857
Description: Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar
Source: Clinical Review by Code List PBCWA, Pg 260 Original policy

Premera Blue Cross of Washington prior authorization

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