Mass General Brigham Health Plan Lumbar Spinal Fusion prior authorization requirements (2026)
What Mass General Brigham Health Plan generally requires to approve Lumbar Spinal Fusion (CPT 22612), for Commercial; posture may vary for MGB ACO/MassHealth and ASO plans. Yes. Mass General Brigham Health Plan generally requires prior authorization for Lumbar Spinal Fusion (CPT 22612).
Medical-necessity criteria Mass General Brigham Health Plan generally applies
Prior authorization is required for elective surgery, including spinal surgery, per the Mass General Brigham Health Plan Prior Authorization, Notification, and Referral Guidelines. Reviewed for medical necessity under MGBHP medical policy.
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 Mass General Brigham Health Plan policy.
Commonly required documentation
- Office notes, imaging, and conservative-care documentation supporting medical necessity.
How to submit
- Method: Mass General Brigham Health Plan provider portal
- Portal: MGBHP Provider Portal
Source
Source: MGBHP Prior Authorization, Notification, and Referral Guidelines (resources.massgeneralbrighamhealthplan.org/utilizationmgmt/PAGuide.pdf). Formerly AllWays/Neighborhood Health Plan. Last verified 2026-06-17.
Frequently asked questions
Does Mass General Brigham Health Plan require prior authorization for Lumbar Spinal Fusion?
Yes. Mass General Brigham Health Plan generally requires prior authorization for Lumbar Spinal Fusion (CPT 22612).
What does Mass General Brigham Health Plan require to approve Lumbar Spinal Fusion?
Prior authorization is required for elective surgery, including spinal surgery, per the Mass General Brigham Health Plan Prior Authorization, Notification, and Referral Guidelines. Reviewed for medical necessity under MGBHP medical policy. Always confirm against the current Mass General Brigham Health Plan policy.
How long does a Mass General Brigham Health Plan prior authorization take?
Turnaround varies by plan and submission method. Check the Mass General Brigham Health Plan portal for current timeframes.
Submitting Lumbar Spinal Fusion to Mass General Brigham Health Plan?
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.