Priority Health Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What Priority Health generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for commercial plans. Yes. Priority Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria Priority Health generally applies
Prior authorization via TurningPoint MSK "Spinal surgical procedures" (disc replacement). Single-level/indication criteria in the TurningPoint Provider Guide. [NEEDS CLINICAL SPOT-CHECK]
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 Priority Health policy.
How to submit
- Method: prism -> TurningPoint (myturningpoint-healthcare.com)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — TurningPoint MSK Program — Provider Guide scope (Spinal surgical procedures incl. laminectomy/discectomy, disc replacement, kyphoplasty/vertebroplasty; femoroacetabular hip arthroscopy; knee arthroscopy/meniscal repair) via 08-08-2024 auth-programs notice · effective 2024-09-01.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 Priority Health require prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Yes. Priority Health generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does Priority Health require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization via TurningPoint MSK "Spinal surgical procedures" (disc replacement). Single-level/indication criteria in the TurningPoint Provider Guide. [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current Priority Health policy.
How long does a Priority Health prior authorization take?
Turnaround varies by plan and submission method. Check the Priority Health portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Lumbar Spine) to Priority 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.