Oxford Health Plans Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What Oxford Health Plans generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for commercial plans. Yes. Oxford Health Plans generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria Oxford Health Plans generally applies
Prior authorization required; proven/medically necessary for SINGLE LEVEL only — skeletally mature, symptomatic intractable single-level discogenic low back pain, FDA-approved disc (InterQual Custom). Unproven/not medically necessary when combined with a concurrent lumbar fusion (hybrid) or performed at more than one level.
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 Oxford Health Plans policy.
How to submit
- Method: UHC Provider Portal
- Portal: UnitedHealthcare Provider Portal
Sources & verification
- BindingSource — UHC Commercial/Exchange Medical Policy — Total Artificial Disc Replacement for the Spine (2026T0437PP) · effective 2026-02-01.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 Oxford Health Plans require prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Yes. Oxford Health Plans generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does Oxford Health Plans require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization required; proven/medically necessary for SINGLE LEVEL only — skeletally mature, symptomatic intractable single-level discogenic low back pain, FDA-approved disc (InterQual Custom). Unproven/not medically necessary when combined with a concurrent lumbar fusion (hybrid) or performed at more than one level. Always confirm against the current Oxford Health Plans policy.
How long does a Oxford Health Plans prior authorization take?
Turnaround varies by plan and submission method. Check the Oxford Health Plans portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Lumbar Spine) to Oxford Health Plans?
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.