Notification

Musculoskeletal Services (Independence)


Notification Issue Date: 10/16/2018



Policy Attachment


Attachment to Policy # 00.01.66b


Attachment:A

Policy #:00.01.66b

Description:Procedure Codes for Spinal Surgery

Title:Musculoskeletal Services (Independence)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


Musculoskeletal Services: Spinal Surgery Procedure Codes that require precertification/preapproval through AIM Specialty Health® (AIM)

Bone Grafts
20930
20931
20932
20933
20934
20936
20937
20938
Cervical Spine Surgery - Anterior Decompression with Fusion
22551
22552
22554
22830
22585
63081
63082
Cervical Spine Surgery - Anterior Decompression without Fusion
63075
63076
Cervical Spine Surgery - Posterior Decompression with Fusion
22600
22614
22632
22634
22830
22864
Cervical Spine Surgery - Posterior Decompression without Fusion
63001
63015
63020
63035
63040
63043
63045
63048
63050
63051
Cervical Total Disc Replacement (Arthroplasty)
22856
22858
22861
0098T
22864
0095T
Lumbar Fusion
22533
22534
22558
22585
22612
22614
22630
22632
22633
22634
22830
22865
Lumbar Decompression (Laminotomy/Laminectomy/Discectomy/Formanitomy)
63005
63012
63017
63030
63035
63042
63044
63047
63048
63056
63057
S2350
S2351
Spinal Deformity (Scoliosis/Kyphosis)
22800
22802
22804
22808
22810
22812
22818
22819
22206
22207
22208
22210
22212
22214
22216
22220
22222
22224
22226
63085
63086
63087
63088
63090
63091
63101
63102
63103
63300
63301
63302
63303
63304
63305
63306
63307
63308
22610
Lumbar Disc Replacement (Arthroplasty)
22862
22865
Spinal Instrumentation
22840
22841
22842
22843
22844
22845
22846
22847
22848
22849
22853
22854
22859
Bone Growth Stimulator
E0748
Vertebroplasty, Kyphoplasty
22510
22511
22512
22513
22514
22515
Sacroiliac Joint Fusion
27279



Version Effective Date: 01/14/2019
Version Issued Date: 01/14/2019
Version Reissued Date: N/A

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