Cigna Lumbar Spinal Fusion prior authorization requirements (2026)
What Cigna generally requires to approve Lumbar Spinal Fusion (CPT 22612), for HMO, PPO plans. Yes. Cigna generally requires prior authorization for Lumbar Spinal Fusion (CPT 22612).
Medical-necessity criteria Cigna generally applies
Per Cigna CCP 0303: Documented radiculopathy/neurogenic claudication with concordant MRI/CT findings (stenosis, spondylolisthesis ≥Grade I, instability on flex/ext films). Failure of ≥6 weeks structured conservative therapy (PT, NSAIDs, activity modification) within past 6 months. Persistent functional impairment (ODI/VAS documented). Single-level fusion preferred; multi-level requires additional justification.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Lumbar Spinal Fusion. Confirm the covered diagnosis list against the current Cigna policy.
Commonly required documentation
- H&P, operative plan, MRI/CT report (<12 months), flexion/extension X-rays, PT records (≥6 weeks), pain management notes, conservative tx documentation, ODI/VAS scores, neurological exam findings
How to submit
- Method: portal
- Portal: Cigna for Health Care Professionals
- Typical turnaround: about 5 days
Source
OON covered at lower benefit level. Submit via portal, fax, or phone. Cigna uses internal CCPs—no AIM/Carelon delegation. Last verified 2026-05-18.
Frequently asked questions
Does Cigna require prior authorization for Lumbar Spinal Fusion?
Yes. Cigna generally requires prior authorization for Lumbar Spinal Fusion (CPT 22612).
What does Cigna require to approve Lumbar Spinal Fusion?
Per Cigna CCP 0303: Documented radiculopathy/neurogenic claudication with concordant MRI/CT findings (stenosis, spondylolisthesis ≥Grade I, instability on flex/ext films). Failure of ≥6 weeks structured conservative therapy (PT, NSAIDs, activity modification) within past 6 months. Persistent functional impairment (ODI/VAS documented). Single-level fusion preferred; multi-level requires additional … Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Cigna typically decides Lumbar Spinal Fusion requests in about 5 days. Timeframes vary; check the payer portal.
Submitting Lumbar Spinal Fusion to Cigna?
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.