About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Lumbar Spinal Fusion L37848.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 22533 | HCPCS | Covered |
| 22558 | HCPCS | Covered |
| 22612 | HCPCS | Covered |
| 22630 | HCPCS | Covered |
| 22633 | HCPCS | Covered |
| C41.2 | ICD10CM | Covered |
| C70.1 | ICD10CM | Covered |
| C72.0 | ICD10CM | Covered |
| C72.1 | ICD10CM | Covered |
| D32.1 | ICD10CM | Covered |
| D33.4 | ICD10CM | Covered |
| D42.1 | ICD10CM | Covered |
| D43.4 | ICD10CM | Covered |
| G06.1 | ICD10CM | Covered |
| G07 | ICD10CM | Covered |
| M40.35 | ICD10CM | Covered |
| M40.36 | ICD10CM | Covered |
| M40.37 | ICD10CM | Covered |
| M41.05 | ICD10CM | Covered |
| M41.06 | ICD10CM | Covered |
| M41.07 | ICD10CM | Covered |
| M41.115 | ICD10CM | Covered |
| M41.116 | ICD10CM | Covered |
| M41.117 | ICD10CM | Covered |
| M41.125 | ICD10CM | Covered |
| M41.126 | ICD10CM | Covered |
| M41.127 | ICD10CM | Covered |
| M41.25 | ICD10CM | Covered |
| M41.26 | ICD10CM | Covered |
| M41.27 | ICD10CM | Covered |
| M41.35 | ICD10CM | Covered |
| M41.45 | ICD10CM | Covered |
| M41.46 | ICD10CM | Covered |
| M41.47 | ICD10CM | Covered |
| M41.55 | ICD10CM | Covered |
| M41.56 | ICD10CM | Covered |
| M41.57 | ICD10CM | Covered |
| M41.85 | ICD10CM | Covered |
| M41.86 | ICD10CM | Covered |
| M41.87 | ICD10CM | Covered |
| M43.05 | ICD10CM | Covered |
| M43.06 | ICD10CM | Covered |
| M43.07 | ICD10CM | Covered |
| M43.09 | ICD10CM | Covered |
| M43.15 | ICD10CM | Covered |
| M43.16 | ICD10CM | Covered |
| M43.17 | ICD10CM | Covered |
| M43.5X5 | ICD10CM | Covered |
| M43.5X6 | ICD10CM | Covered |
| M43.5X7 | ICD10CM | Covered |
| M43.8X5 | ICD10CM | Covered |
| M43.8X6 | ICD10CM | Covered |
| M43.8X7 | ICD10CM | Covered |
| M46.25 | ICD10CM | Covered |
| M46.26 | ICD10CM | Covered |
| M46.27 | ICD10CM | Covered |
| M46.35 | ICD10CM | Covered |
| M46.36 | ICD10CM | Covered |
| M46.37 | ICD10CM | Covered |
| M46.39 | ICD10CM | Covered |
| M46.45 | ICD10CM | Covered |
| M46.46 | ICD10CM | Covered |
| M46.47 | ICD10CM | Covered |
| M46.49 | ICD10CM | Covered |
| M46.55 | ICD10CM | Covered |
| M46.56 | ICD10CM | Covered |
| M46.57 | ICD10CM | Covered |
| M46.59 | ICD10CM | Covered |
| M47.15 | ICD10CM | Covered |
| M47.16 | ICD10CM | Covered |
| M47.25 | ICD10CM | Covered |
| M47.26 | ICD10CM | Covered |
| M47.27 | ICD10CM | Covered |
| M48.35 | ICD10CM | Covered |
| M48.36 | ICD10CM | Covered |
| M48.37 | ICD10CM | Covered |
| M48.45XA | ICD10CM | Covered |
| M48.45XD | ICD10CM | Covered |
| M48.45XG | ICD10CM | Covered |
| M48.45XS | ICD10CM | Covered |
| M48.46XA | ICD10CM | Covered |
| M48.46XD | ICD10CM | Covered |
| M48.46XG | ICD10CM | Covered |
| M48.46XS | ICD10CM | Covered |
| M48.47XA | ICD10CM | Covered |
| M48.47XD | ICD10CM | Covered |
| M48.47XG | ICD10CM | Covered |
| M48.47XS | ICD10CM | Covered |
| M48.55XA | ICD10CM | Covered |
| M48.55XD | ICD10CM | Covered |
| M48.55XG | ICD10CM | Covered |
| M48.55XS | ICD10CM | Covered |
| M48.56XA | ICD10CM | Covered |
| M48.56XD | ICD10CM | Covered |
| M48.56XG | ICD10CM | Covered |
| M48.56XS | ICD10CM | Covered |
| M48.57XA | ICD10CM | Covered |
| M48.57XD | ICD10CM | Covered |
| M48.57XG | ICD10CM | Covered |
| M48.57XS | ICD10CM | Covered |
| M51.05 | ICD10CM | Covered |
| M51.06 | ICD10CM | Covered |
| M51.15 | ICD10CM | Covered |
| M51.16 | ICD10CM | Covered |
| M51.17 | ICD10CM | Covered |
| M53.2X5 | ICD10CM | Covered |
| M53.2X6 | ICD10CM | Covered |
| M53.2X7 | ICD10CM | Covered |
| M54.15 | ICD10CM | Covered |
| M54.16 | ICD10CM | Covered |
| M54.17 | ICD10CM | Covered |
| M80.08XA | ICD10CM | Covered |
| M80.08XD | ICD10CM | Covered |
| M80.08XG | ICD10CM | Covered |
| M80.08XK | ICD10CM | Covered |
| M80.08XP | ICD10CM | Covered |
| M80.08XS | ICD10CM | Covered |
| M80.0AXA | ICD10CM | Covered |
| M80.0AXD | ICD10CM | Covered |
| M80.0AXG | ICD10CM | Covered |
| M80.0AXK | ICD10CM | Covered |
| M80.0AXP | ICD10CM | Covered |
| M80.0AXS | ICD10CM | Covered |
| M80.88XA | ICD10CM | Covered |
| M80.88XD | ICD10CM | Covered |
| M80.88XG | ICD10CM | Covered |
| M80.88XK | ICD10CM | Covered |
| M80.88XP | ICD10CM | Covered |
| M80.88XS | ICD10CM | Covered |
| M80.8AXA | ICD10CM | Covered |
| M80.8AXD | ICD10CM | Covered |
| M80.8AXG | ICD10CM | Covered |
| M80.8AXK | ICD10CM | Covered |
| M80.8AXP | ICD10CM | Covered |
| M80.8AXS | ICD10CM | Covered |
| M96.0 | ICD10CM | Covered |
| S32.010A | ICD10CM | Covered |
| S32.010B | ICD10CM | Covered |
| S32.010D | ICD10CM | Covered |
| S32.010G | ICD10CM | Covered |
| S32.010K | ICD10CM | Covered |
| S32.010S | ICD10CM | Covered |
| S32.011A | ICD10CM | Covered |
| S32.011B | ICD10CM | Covered |
| S32.011D | ICD10CM | Covered |
| S32.011G | ICD10CM | Covered |
| S32.011K | ICD10CM | Covered |
| S32.011S | ICD10CM | Covered |
| S32.012A | ICD10CM | Covered |
| S32.012B | ICD10CM | Covered |
| S32.012D | ICD10CM | Covered |
| S32.012G | ICD10CM | Covered |
| S32.012K | ICD10CM | Covered |
| S32.012S | ICD10CM | Covered |
| S32.018A | ICD10CM | Covered |
| S32.018B | ICD10CM | Covered |
| S32.018D | ICD10CM | Covered |
| S32.018G | ICD10CM | Covered |
| S32.018K | ICD10CM | Covered |
| S32.018S | ICD10CM | Covered |
| S32.019A | ICD10CM | Covered |
| S32.019B | ICD10CM | Covered |
| S32.019D | ICD10CM | Covered |
| S32.019G | ICD10CM | Covered |
| S32.019K | ICD10CM | Covered |
| S32.019S | ICD10CM | Covered |
| S32.020A | ICD10CM | Covered |
| S32.020B | ICD10CM | Covered |
| S32.020D | ICD10CM | Covered |
| S32.020G | ICD10CM | Covered |
| S32.020K | ICD10CM | Covered |
| S32.020S | ICD10CM | Covered |
| S32.021A | ICD10CM | Covered |
| S32.021B | ICD10CM | Covered |
| S32.021D | ICD10CM | Covered |
| S32.021G | ICD10CM | Covered |
| S32.021K | ICD10CM | Covered |
| S32.021S | ICD10CM | Covered |
| S32.022A | ICD10CM | Covered |
| S32.022B | ICD10CM | Covered |
| S32.022D | ICD10CM | Covered |
| S32.022G | ICD10CM | Covered |
| S32.022K | ICD10CM | Covered |
| S32.022S | ICD10CM | Covered |
| S32.028A | ICD10CM | Covered |
| S32.028B | ICD10CM | Covered |
| S32.028D | ICD10CM | Covered |
| S32.028G | ICD10CM | Covered |
| S32.028K | ICD10CM | Covered |
| S32.028S | ICD10CM | Covered |
| S32.029A | ICD10CM | Covered |
| S32.029B | ICD10CM | Covered |
| S32.029D | ICD10CM | Covered |
| S32.029G | ICD10CM | Covered |
| S32.029K | ICD10CM | Covered |
| S32.029S | ICD10CM | Covered |
| S32.030A | ICD10CM | Covered |
| S32.030B | ICD10CM | Covered |
| S32.030D | ICD10CM | Covered |
| S32.030G | ICD10CM | Covered |
| S32.030K | ICD10CM | Covered |
| S32.030S | ICD10CM | Covered |
| S32.031A | ICD10CM | Covered |
| S32.031B | ICD10CM | Covered |
| S32.031D | ICD10CM | Covered |
| S32.031G | ICD10CM | Covered |
| S32.031K | ICD10CM | Covered |
| S32.031S | ICD10CM | Covered |
| S32.032A | ICD10CM | Covered |
| S32.032B | ICD10CM | Covered |
| S32.032D | ICD10CM | Covered |
| S32.032G | ICD10CM | Covered |
| S32.032K | ICD10CM | Covered |
| S32.032S | ICD10CM | Covered |
| S32.038A | ICD10CM | Covered |
| S32.038B | ICD10CM | Covered |
| S32.038D | ICD10CM | Covered |
| S32.038G | ICD10CM | Covered |
| S32.038K | ICD10CM | Covered |
| S32.038S | ICD10CM | Covered |
| S32.039A | ICD10CM | Covered |
| S32.039B | ICD10CM | Covered |
| S32.039D | ICD10CM | Covered |
| S32.039G | ICD10CM | Covered |
| S32.039K | ICD10CM | Covered |
| S32.039S | ICD10CM | Covered |
| S32.040A | ICD10CM | Covered |
| S32.040B | ICD10CM | Covered |
| S32.040D | ICD10CM | Covered |
| S32.040G | ICD10CM | Covered |
| S32.040K | ICD10CM | Covered |
| S32.040S | ICD10CM | Covered |
| S32.041A | ICD10CM | Covered |
| S32.041B | ICD10CM | Covered |
| S32.041D | ICD10CM | Covered |
| S32.041G | ICD10CM | Covered |
| S32.041K | ICD10CM | Covered |
| S32.041S | ICD10CM | Covered |
| S32.042A | ICD10CM | Covered |
| S32.042B | ICD10CM | Covered |
| S32.042D | ICD10CM | Covered |
| S32.042G | ICD10CM | Covered |
| S32.042K | ICD10CM | Covered |
| S32.042S | ICD10CM | Covered |
| S32.048A | ICD10CM | Covered |
| S32.048B | ICD10CM | Covered |
| S32.048D | ICD10CM | Covered |
| S32.048G | ICD10CM | Covered |
| S32.048K | ICD10CM | Covered |
| S32.048S | ICD10CM | Covered |
| S32.049A | ICD10CM | Covered |
| S32.049B | ICD10CM | Covered |
| S32.049D | ICD10CM | Covered |
| S32.049G | ICD10CM | Covered |
| S32.049K | ICD10CM | Covered |
| S32.049S | ICD10CM | Covered |
| S32.050A | ICD10CM | Covered |
| S32.050B | ICD10CM | Covered |
| S32.050D | ICD10CM | Covered |
| S32.050G | ICD10CM | Covered |
| S32.050K | ICD10CM | Covered |
| S32.050S | ICD10CM | Covered |
| S32.051A | ICD10CM | Covered |
| S32.051B | ICD10CM | Covered |
| S32.051D | ICD10CM | Covered |
| S32.051G | ICD10CM | Covered |
| S32.051K | ICD10CM | Covered |
| S32.051S | ICD10CM | Covered |
| S32.052A | ICD10CM | Covered |
| S32.052B | ICD10CM | Covered |
| S32.052D | ICD10CM | Covered |
| S32.052G | ICD10CM | Covered |
| S32.052K | ICD10CM | Covered |
| S32.052S | ICD10CM | Covered |
| S32.058A | ICD10CM | Covered |
| S32.058B | ICD10CM | Covered |
| S32.058D | ICD10CM | Covered |
| S32.058G | ICD10CM | Covered |
| S32.058K | ICD10CM | Covered |
| S32.058S | ICD10CM | Covered |
| S32.059A | ICD10CM | Covered |
| S32.059B | ICD10CM | Covered |
| S32.059D | ICD10CM | Covered |
| S32.059G | ICD10CM | Covered |
| S32.059K | ICD10CM | Covered |
| S32.059S | ICD10CM | Covered |
| S33.0XXA | ICD10CM | Covered |
| S33.0XXD | ICD10CM | Covered |
| S33.0XXS | ICD10CM | Covered |
| S33.110A | ICD10CM | Covered |
| S33.110D | ICD10CM | Covered |
| S33.110S | ICD10CM | Covered |
| S33.111A | ICD10CM | Covered |
| S33.111D | ICD10CM | Covered |
| S33.111S | ICD10CM | Covered |
| S33.120A | ICD10CM | Covered |
| S33.120D | ICD10CM | Covered |
| S33.120S | ICD10CM | Covered |
| S33.121A | ICD10CM | Covered |
| S33.121D | ICD10CM | Covered |
| S33.121S | ICD10CM | Covered |
| S33.130A | ICD10CM | Covered |
| S33.130D | ICD10CM | Covered |
| S33.130S | ICD10CM | Covered |
| S33.131A | ICD10CM | Covered |
| S33.131D | ICD10CM | Covered |
| S33.131S | ICD10CM | Covered |
| S33.140A | ICD10CM | Covered |
| S33.140D | ICD10CM | Covered |
| S33.140S | ICD10CM | Covered |
| S33.141A | ICD10CM | Covered |
| S33.141D | ICD10CM | Covered |
| S33.141S | ICD10CM | Covered |