Clover Health Artificial Intervertebral Disc Surgery (Cervical Spine) prior authorization requirements (2026)
What Clover Health generally requires to approve Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861), for medicare_advantage plans. Yes. Clover Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
Medical-necessity criteria Clover Health generally applies
Prior authorization required via eviCore (cervical TDR criteria mirror CMM-602). There is no CMS NCD for cervical artificial disc, so eviCore / MA local coverage governs (single or two contiguous levels C3-C7, FDA-approved disc, failed conservative care).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Artificial Intervertebral Disc Surgery (Cervical Spine). Confirm the covered diagnosis list against the current Clover Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-602 Cervical Total Disc Arthroplasty (no NCD for cervical disc) (CMM-602) · effective 2025-07-01.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 Clover Health require prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine)?
Yes. Clover Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
What does Clover Health require to approve Artificial Intervertebral Disc Surgery (Cervical Spine)?
Prior authorization required via eviCore (cervical TDR criteria mirror CMM-602). There is no CMS NCD for cervical artificial disc, so eviCore / MA local coverage governs (single or two contiguous levels C3-C7, FDA-approved disc, failed conservative care). 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 Artificial Intervertebral Disc Surgery (Cervical Spine) 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.