Lumbar Artificial Disc Replacement
JJ · Effective May 6, 2019
3 active Medicare policies list 22857, and 16 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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JJ · Effective May 6, 2019
JM · Effective May 6, 2019
National · Effective Jan 1, 2023
16 policies from 13 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 22857 |
|---|---|---|
| Cigna Commercial Spine Surgery Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Intraoperative Monitoring | Sep 15, 2025 | Covered with conditions |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Spine Surgery | Sep 19, 2026 | Covered |
| Spine Surgery [for Wellpoint Massachusetts] | Nov 15, 2025 | Covered |
|---|
| Policy | Effective | Status of 22857 |
|---|---|---|
| Artificial Intervertebral Disc | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Artificial Intervertebral Disc | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Artificial Intervertebral Disc | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Artificial Intervertebral Disc | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| EOCCO Spine Surgery Code List | May 1, 2026 | Prior auth required |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Health Partners Plans Spine Surgery Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Artificial Intervertebral Disc Replacement | Apr 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Total Artificial Disc Replacement for the Spine | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| The Health Plan Spine Surgery Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Total Artificial Disc Replacement for the Spine | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 22857 |
|---|---|---|
| Total Artificial Disc Replacement for the Spine | Feb 1, 2026 | Covered |