Oscar Health Artificial Intervertebral Disc Surgery (Cervical Spine) prior authorization requirements (2026)
What Oscar Health generally requires to approve Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861), for commercial plans. Yes. Oscar Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
Medical-necessity criteria Oscar Health generally applies
Prior authorization required via eviCore (CMM-602 Cervical Total Disc Arthroplasty). Single-level or contiguous two-level reconstruction at C3-C7 via an anterior approach following discectomy; skeletally mature; no prior surgery at the operative level; clinically significant daily pain; at least 6 weeks physician-directed conservative care (unless contraindicated); MRI/CT showing neural compression at the requested level(s).
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 Oscar Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-602 Cervical Total Disc Arthroplasty (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 Oscar Health require prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine)?
Yes. Oscar Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Cervical Spine) (CPT 22856, 22858, 22861).
What does Oscar Health require to approve Artificial Intervertebral Disc Surgery (Cervical Spine)?
Prior authorization required via eviCore (CMM-602 Cervical Total Disc Arthroplasty). Single-level or contiguous two-level reconstruction at C3-C7 via an anterior approach following discectomy; skeletally mature; no prior surgery at the operative level; clinically significant daily pain; at least 6 weeks physician-directed conservative care (unless contraindicated); MRI/CT showing neural compressio… Always confirm against the current Oscar Health policy.
How long does a Oscar Health prior authorization take?
Turnaround varies by plan and submission method. Check the Oscar Health portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Cervical Spine) to Oscar 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.