Clover Health Anterior Cervical Discectomy and Fusion prior authorization requirements (2026)
What Clover Health generally requires to approve Anterior Cervical Discectomy and Fusion (CPT 22551), for medicare_advantage plans. Yes. Clover Health generally requires prior authorization for Anterior Cervical Discectomy and Fusion (CPT 22551).
Medical-necessity criteria Clover Health generally applies
Prior authorization required for cervical fusion/ACDF via eviCore (Spine Surgery program).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Anterior Cervical Discectomy and Fusion. Confirm the covered diagnosis list against the current Clover Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — Clover Health — Interventional Pain, Spine and Joint Surgeries (eviCore).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 2026-06-25.
Frequently asked questions
Does Clover Health require prior authorization for Anterior Cervical Discectomy and Fusion?
Yes. Clover Health generally requires prior authorization for Anterior Cervical Discectomy and Fusion (CPT 22551).
What does Clover Health require to approve Anterior Cervical Discectomy and Fusion?
Prior authorization required for cervical fusion/ACDF via eviCore (Spine Surgery program). Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting Anterior Cervical Discectomy and Fusion to Clover 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.