Blue Cross and Blue Shield of Montana prior authorization 22857

Blue Cross and Blue Shield of Montana prior authorization for 22857: Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Single Interspace Lumbar

Code: 22857
Description: Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Single Interspace Lumbar
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 29 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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