Oscar Health Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What Oscar Health generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for commercial plans. Yes. Oscar Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria Oscar Health generally applies
Prior authorization required via eviCore (CMM-610 Lumbar Total Disc). Age 18-60; single-level at L3-L4, L4-L5, or L5-S1; FDA-approved disc; no planned simultaneous (hybrid) fusion; absence of facet ankylosis/severe facet degeneration; imaging shows moderate-to-severe single-level DDD with no DDD at more than one level and none above L3-L4; at least 6 consecutive months failed multimodal conservative care; no unmanaged behavioral-health disorder.
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 Oscar Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-610 Lumbar Total Disc Arthroplasty (CMM-610) · effective 2024-11-01.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 (Lumbar Spine)?
Yes. Oscar Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does Oscar Health require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization required via eviCore (CMM-610 Lumbar Total Disc). Age 18-60; single-level at L3-L4, L4-L5, or L5-S1; FDA-approved disc; no planned simultaneous (hybrid) fusion; absence of facet ankylosis/severe facet degeneration; imaging shows moderate-to-severe single-level DDD with no DDD at more than one level and none above L3-L4; at least 6 consecutive months failed multimodal conservati… 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 (Lumbar 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.