`22899` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 22899

100 of 100 payer prior-auth lists that name 22899 require prior authorization or set conditions: Blue Shield of California, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Musculoskeletal	All	prior auth required		Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Musculoskeletal	All	prior auth required		Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Spine Surgery
HealthSpring	Medicare Advantage	All	prior auth required		Jan 1, 2025	2026 Q4 Prior Authorization List
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth required		Jan 1, 2027	1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
Humana	Humana D-SNP (SC)	SC	prior auth required		Jan 1, 2027	Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	IN	prior auth required		Jan 1, 2027	1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
Humana	Humana Healthy Horizons	KY	prior auth required		Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	OH	prior auth required		Jan 1, 2027	555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
Humana	Humana Healthy Horizons	SC	prior auth required		Jan 1, 2027	Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Humana Puerto Rico MA and Dual Medicare-Medicaid	PR	prior auth required		Nov 3, 2025	Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Musculoskeletal	All	prior auth required			Humana Prior Authorization List (PAL): Musculoskeletal Services
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Complete Care (Virginia)	Medicare-only PA matrix for D-SNP	VA	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of Arizona	Medicare-only PA matrix for D-SNP	AZ	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of California	Medicare Advantage	CA	prior auth required		Jul 1, 2021	Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Medicaid	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required		Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required		Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required		Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of New Mexico	Medicare Advantage	NM	prior auth required		Jan 1, 2021	Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Medicare and MyCare Ohio (MMP) Medicare	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of South Carolina	Medicare Advantage	SC	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required		Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Texas	Exchange	TX	prior auth required		Sep 1, 2019	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of Wisconsin	Medicare Advantage	WI	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)	Molina national (MHI) Medicare grid	All	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required		Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
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
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	Preferred Care Network and Preferred Care Partners of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida 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 Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required	Excluded plans: Erickson Advantage	Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements 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	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth required		Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Louisiana Medicaid (Healthy Louisiana)	LA	prior auth required		Jan 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Massachusetts OneCare	MA	prior auth required		Nov 1, 2025	Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO)	MA	prior auth required		Nov 1, 2025	CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO) and OneCare	MA	prior auth required		Oct 1, 2026	Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community Plan	Michigan Medicaid, Healthy Michigan Plan, CSHCS	MI	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Michigan, Healthy Michigan Plan and Children’s Special Health Care Services Effective October 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth required		Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Missouri Medicaid	MO	prior auth required		Jul 1, 2026	Prior authorization requirements for Missouri Medicaid Effective July 1, 2026

Payer coverage policies that name 22899

22899 appears in 136 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Molina Healthcare, Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Intraoperative Neurophysiological Monitoring (0697)	covered if criteria are met	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
Anthem	Axial Lumbar Interbody Fusion (SURG.00111)	unproven / investigational	May 14, 2026	payer document
Anthem	Percutaneous Spinal Surgery (SURG.00071)	unproven / investigational	May 14, 2026	payer document
Anthem	Percutaneous Vertebral Disc Procedures (SURG.00052)	unproven / investigational	May 14, 2026	payer document
Anthem	Spinal Hardware: Investigational (SURG.00167)	unproven / investigational	Aug 13, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Interspinous Fixation Fusion Devices (A.7.01.138)	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Interventions For Progressive Scoliosis	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Nonpedicle Supplemental Fixation Device For Use In The Noncervical Spine (L.7.01.408)	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Percutaneous Intradiscal Electrothermal Annuloplasty Radiofrequency Annuloplasty Biacuplasty And Intraosseous Basivertebral Nerve Ablation	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Radiofrequency Ablation Of Miscellaneous Solid Tumors Excluding Liver Tumors	unproven / investigational		payer document
Blue Cross & Blue Shield of Rhode Island	Interspinous Fixation (Fusion) Devices	not covered	Sep 2, 2026	payer document
Blue Cross NC	Interspinous Fixation (Fusion) Devices	listed, no stance	May 1, 2026	payer document
Blue Cross NC	Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers)	listed, no stance	May 1, 2026	payer document
Blue Shield of California	BSC7.21 \| Skeletal Remodeling	listed, no stance		payer document
Blue Shield of California	Vertical Expandable Prosthetic Titanium Rib (7.01.110)	listed, no stance		payer document
Blue Shield of California	\| Interventions for Progressive Scoliosis (2.01.83)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Annular Closure Devices (e.g., Barricaid®, Xclose®, Inclose™) (CAM 374) Number	listed, no stance	Nov 1, 2025	payer document
BlueCross BlueShield of South Carolina	Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers) (CAM 701107)	listed, no stance	Jun 1, 2026	payer document
BlueCross BlueShield of South Carolina	Vertical Expandable Prosthetic Titanium Rib (CAM 701110)	listed, no stance	Jun 1, 2026	payer document
Centene	Intradiscal Steroid Injections for Pain Management (CP.MP.167)	covered if criteria are met	Jul 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Annulus Closure After Discectomy (SUR705.045)	listed, no stance	Dec 1, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Axial Lumbosacral Interbody Fusion (SUR712.038)	listed, no stance	Oct 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Interspinous Fixation (Fusion) Devices (SUR712.040)	listed, no stance	Nov 15, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Vertical Expandable Prosthetic Titanium Rib (SUR705.025)	listed, no stance	Aug 1, 2026	payer document
Molina Healthcare	Stem Cell Therapy for Orthopedic Applications Policy No. 426 (426)	listed, no stance	Oct 8, 2025	payer document
Premera Blue Cross	Axial Lumbosacral Interbody Fusion (7.01.130)	listed, no stance	Jun 8, 2026	payer document
Premera Blue Cross	Lumbar Spine Decompression Surgery: Discectomy, Foraminotomy, Laminotomy, Laminectomy in Adults (7.01.551)	listed, no stance	Aug 24, 2026	payer document
Regence	Artificial Intervertebral Disc (Surgery 127)	listed, no stance	May 1, 2026	payer document
Regence	Dynamic Stabilization of the Spine (Surgery 143)	listed, no stance	Jul 1, 2026	payer document
Regence	Interspinous Fixation (Fusion) Devices (Surgery 172)	listed, no stance	Feb 1, 2026	payer document
Regence	Interspinous and Interlaminar Stabilization and Distraction Devices (Spacers) (Surgery 155)	listed, no stance	Jul 1, 2026	payer document
Regence	Orthopedic Applications of Stem Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow (Medicine 142)	listed, no stance	Dec 1, 2025	payer document
Regence	Percutaneous Axial Lumbosacral Interbody Fusion (LIF) (Surgery 157)	listed, no stance	Jul 1, 2026	payer document
Regence	Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, and Biacuplasty (Surgery 118)	listed, no stance	Apr 1, 2026	payer document
Regence	Sacroiliac Joint Fusion (Surgery 193)	listed, no stance	Dec 1, 2025	payer document
Regence	Vertebral Body Tethering and Stapling (Surgery 232)	listed, no stance	Jan 1, 2026	payer document
Regence	Vertical Expandable Prosthetic Titanium Rib (Surgery 159)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (CS001.T)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (2026T0107II)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Idaho Only) (CS001ID.B)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Kansas Only) (CS001KS.02)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Kentucky Only) (CS001KY.10)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Nebraska Only) (CS001NE.T)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for New Jersey Only) (CS001NJ.Q)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for New Mexico Only) (CS001NM.C)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Ohio Only) (CS001OH.D)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Pennsylvania Only) (CS001PA.Q)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Ablative Treatment for Spinal Pain (for Tennessee Only) (CS001TN.R)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (CS031.T)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (2026T0105EE)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Idaho Only) (CS031ID.B)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Kansas Only) (CS031KS.02)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Kentucky Only) (CS031KY.06)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Nebraska Only) (CS031NE.T)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for New Jersey Only) (CS031NJ.R)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for New Mexico Only) (CS031NM.C)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for North Carolina Only) (CSNCT0105.04)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Ohio Only) (CS031OH.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Pennsylvania Only) (CS031PA.R)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Discogenic Pain Treatment (for Tennessee Only) (CS031TN.R)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (2026T0638H)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (CS363.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Idaho Only) (CS363ID.C)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Kansas Only) (CS363KS.02)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Kentucky Only) (CS363KY.04)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Nebraska Only) (CS363NE.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for New Jersey Only) (CS363NJ.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for New Mexico Only) (CS363NM.C)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for North Carolina Only) (CSNCT0363.04)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Ohio Only) (CS363OH.D)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Pennsylvania Only) (CS363PA.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Interspinous Fusion and Decompression Devices (for Tennessee Only) (CS363TN.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (CS364.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (2026T0640H)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Idaho Only) (CS364ID.B)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Kansas Only) (CS364KS.02)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Kentucky Only) (CS364KY.04)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Nebraska Only) (CS364NE.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for New Jersey Only) (CS364NJ.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for New Mexico Only) (CS364NM.C)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for North Carolina Only) (CSNCT0364.04)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Ohio Only) (CS364OH.D)	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Pennsylvania Only) (CS364PA.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Minimally Invasive Spine Surgery Procedures (for Tennessee Only) (CS364TN.D)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Pain Management (MMP070.12) when used to report the Intracept procedure	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (CS009.V)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (2026T0410KK)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Idaho Only) (CS009ID.D)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Kansas Only) (CS009KS.02)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Kentucky Only) (CS009KY.08)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Nebraska Only) (CS009NE.V)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for New Jersey Only) (CS009NJ.S)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for New Mexico Only) (CS009NM.C)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for North Carolina Only) (CSNCT0410.05)	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Ohio Only) (CS009OH.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Spinal Fusion and Bone Healing Enhancement Products (for Pennsylvania Only) (CS009PA.T)	listed, no stance	Dec 1, 2025	payer document

Recent prior-auth changes

Sep 1, 2026: PA added, Blue Shield of California
Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
Jan 1, 2026: PA removed, Molina Healthcare of Michigan
Mar 1, 2025: PA added, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in FL, KY, VT, WA, WV, WY.

AZ: $149.49 (outpatient_hospital), effective Oct 1, 2021
FL: $864.44 (physician, non-facility), effective Jan 1, 2026
IN: $0.00 (professional, facility), effective Oct 15, 2020
KY: $45.00 (asc), effective Jan 1, 2026
MS: $187.32 (comprehensive), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
OK: $0.00 (physician, non-facility), effective Jul 1, 2026
TX: $0.00 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Jan 1, 2010
VT: $191.53 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $109.09 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

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.

22899 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 22899

Payer coverage policies that name 22899

Recent prior-auth changes

Medicaid fee-for-service

`22899` CPT® code: payer coverage and prior authorization