NY State Workers' Comp Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for workers_comp plans. Yes. NY State Workers' Comp generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria NY State Workers' Comp generally applies
Lumbar artificial disc replacement — request prior authorization via OnBoard (on the 324.3 always-PA list, MTG Appendix E). Indicated for single-level lumbar DDD L3-S1 with radiculopathy unresponsive to conservative care; skeletally mature WITHOUT osteoporosis, severe spondylosis, severe facet pathology, lumbar instability, fracture, renal failure, severe diabetes, or infection; FDA-approved disc. Multilevel DDD is experimental/investigational.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Artificial Intervertebral Disc Surgery (Lumbar 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 Mid and Low Back 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 (Lumbar Spine)?
Yes. NY State Workers' Comp generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does NY State Workers' Comp require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Lumbar artificial disc replacement — request prior authorization via OnBoard (on the 324.3 always-PA list, MTG Appendix E). Indicated for single-level lumbar DDD L3-S1 with radiculopathy unresponsive to conservative care; skeletally mature WITHOUT osteoporosis, severe spondylosis, severe facet pathology, lumbar instability, fracture, renal failure, severe diabetes, or infection; FDA-approved disc.… 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 (Lumbar 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.