Oxford Health Plans Spinal Fusion Surgery prior authorization requirements (2026)
What Oxford Health Plans generally requires to approve Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280), for commercial plans. Yes. Oxford Health Plans generally requires prior authorization for Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280).
Medical-necessity criteria Oxford Health Plans generally applies
Prior authorization required for spine surgery/fusion (site of service reviewed). UnitedHealthcare Provider Portal; UnitedHealthcare/Optum review.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Spinal Fusion Surgery. 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 — Prior Authorization Requirements for Oxford (PCA-1-22-03771) · effective 2026-01-01.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 2026-06-25.
Frequently asked questions
Does Oxford Health Plans require prior authorization for Spinal Fusion Surgery?
Yes. Oxford Health Plans generally requires prior authorization for Spinal Fusion Surgery (CPT C1821, 22102, 22103, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22853, 22854, 22859, 27278, 27279, 27280).
What does Oxford Health Plans require to approve Spinal Fusion Surgery?
Prior authorization required for spine surgery/fusion (site of service reviewed). UnitedHealthcare Provider Portal; UnitedHealthcare/Optum review. 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 Spinal Fusion Surgery 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.