Braven Health Spinal Fusion Surgery prior authorization requirements (2026)
What Braven Health generally requires to approve Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280, 20930, 20931, 20936, 20937, 20938), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280, 20930, 20931, 20936, 20937, 20938).
Medical-necessity criteria Braven Health generally applies
Prior authorization required — Spine Services lists "Spinal Fusion Surgeries (Cervical, Lumbar, Thoracic, Sacral, Scoliosis)" under TurningPoint, Braven in scope. Documented standard: conservative therapy attempted first; PT notes, radiographic findings, and a documented surgical plan required. Exact numeric criteria in TurningPoint's policy library (portal).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Spinal Fusion Surgery. Confirm the covered diagnosis list against the current Braven Health policy.
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 (Braven in scope).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 Spinal Fusion Surgery?
Yes. Braven Health generally requires prior authorization for Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280, 20930, 20931, 20936, 20937, 20938).
What does Braven Health require to approve Spinal Fusion Surgery?
Prior authorization required — Spine Services lists "Spinal Fusion Surgeries (Cervical, Lumbar, Thoracic, Sacral, Scoliosis)" under TurningPoint, Braven in scope. Documented standard: conservative therapy attempted first; PT notes, radiographic findings, and a documented surgical plan required. Exact numeric criteria in TurningPoint's policy library (portal). 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 Spinal Fusion Surgery 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.