22216 CPT® code: payer coverage and prior authorization20 of 20 payer prior-auth lists that name 22216 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, Cigna, Humana, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | FEP Blue Focus only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Aetna | Commercial | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Medicare Advantage | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Aug 23, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Aug 23, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs |
| Cigna | Musculoskeletal | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Spine Surgery |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth required | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 | |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| Surest | Surest health plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
22216 appears in 20 coverage policies from Aetna, BlueCross BlueShield of South Carolina, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance | Oct 6, 2026 | payer document |
| Aetna | Idiopathic Scoliosis (0398) | covered if criteria are met | Sep 28, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met (range 22206-22226) | Jun 19, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered (range 22010-22899) | Jun 19, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 22010-22899) | Jul 23, 2026 | payer document |
| Aetna | Remote Ischemic Conditioning (0814) | listed, no stance (range 20000-29999) | Nov 20, 2025 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 20100-29999) | Jul 29, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | covered if criteria are met | Jul 30, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | listed, no stance | Jul 30, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Spinal Deformity Surgery (CAM 399) 22214 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (2026T0639J) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (CS365.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Idaho Only) (CS365ID.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Kansas Only) (CS365KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Kentucky Only) (CS365KY.05) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for New Jersey Only) (CS365NJ.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for New Mexico Only) (CS365NM.C) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for North Carolina Only) (CSNCT0365.05) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Ohio Only) (CS365OH.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Pennsylvania Only) (CS365PA.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Tennessee Only) (CS365TN.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | This Medical Policy only applies to the State of Nebraska. (CS365NE.E) | listed, no stance | May 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.