NY State Workers' Comp Artificial Intervertebral Disc Surgery (Cervical Spine) prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861), for workers_comp plans. Yes. NY State Workers' Comp generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
Medical-necessity criteria NY State Workers' Comp generally applies
Cervical artificial disc replacement — request prior authorization via OnBoard (MTG Appendix E procedure). Indicated for skeletally mature patients with one level or two contiguous levels C3-C7 with radiculopathy and/or myelopathy, after failed conservative care (documented failure of at least 6 consecutive weeks of two conservative modalities; at least 6 months nonsurgical care), an FDA-approved disc, and imaging-confirmed neural compression. Not for 3-plus-level disease.
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 NY State Workers' Comp policy.
How to submit
- Method: OnBoard PAR
- Portal: NY WCB OnBoard
Sources & verification
- BindingSource — NY WCB Neck Injury Medical Treatment Guidelines (Appendix E) · effective 2022-05-02.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 NY State Workers' Comp require prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine)?
Yes. NY State Workers' Comp generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
What does NY State Workers' Comp require to approve Artificial Intervertebral Disc Surgery (Cervical Spine)?
Cervical artificial disc replacement — request prior authorization via OnBoard (MTG Appendix E procedure). Indicated for skeletally mature patients with one level or two contiguous levels C3-C7 with radiculopathy and/or myelopathy, after failed conservative care (documented failure of at least 6 consecutive weeks of two conservative modalities; at least 6 months nonsurgical care), an FDA-approved … Always confirm against the current NY State Workers' Comp policy.
How long does a NY State Workers' Comp prior authorization take?
Turnaround varies by plan and submission method. Check the NY State Workers' Comp portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Cervical Spine) to NY State Workers' Comp?
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.