Braven Health Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What Braven Health generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria Braven Health generally applies
Prior authorization via TurningPoint Spine Services (Lumbar Disc Replacement — CPT 22857/22860/22862/22865). NOTE: as a Medicare Advantage plan, CMS NCD 150.10 applies — lumbar artificial disc replacement (LADR) is nationally NON-COVERED for beneficiaries over age 60; for age <=60 there is no NCD (MAC/plan discretion). [NEEDS CLINICAL SPOT-CHECK]
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Artificial Intervertebral Disc Surgery (Lumbar Spine). Confirm the covered diagnosis list against the current Braven Health policy.
Situations to verify before submitting
Braven Health may not cover Artificial Intervertebral Disc Surgery (Lumbar Spine) in these situations. Verify against the current policy rather than assuming a denial:
- CMS NCD 150.10: LADR non-covered for Medicare beneficiaries over 60 years of age.
How to submit
- Method: TurningPoint (Availity / portal / 1-833-436-4083)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Surgical & Implantable Device Management Program — Spine Services (procedure-code list incl. laminectomy/discectomy, cervical & lumbar disc replacement, vertebral augmentation).View
- BindingSource — NCD 150.10 — Lumbar Artificial Disc Replacement (LADR): nationally non-covered for beneficiaries over age 60 (NCD 150.10).View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does Braven Health require prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Yes. Braven Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does Braven Health require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization via TurningPoint Spine Services (Lumbar Disc Replacement — CPT 22857/22860/22862/22865). NOTE: as a Medicare Advantage plan, CMS NCD 150.10 applies — lumbar artificial disc replacement (LADR) is nationally NON-COVERED for beneficiaries over age 60; for age <=60 there is no NCD (MAC/plan discretion). [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Lumbar Spine) to Braven Health?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.