QualCare Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What QualCare generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for commercial plans. Yes. QualCare generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria QualCare generally applies
Prior authorization via eviCore (Cigna CMM-610). Age 18-60; single-level L3-S1; FDA-approved disc; no hybrid fusion; no facet ankylosis; moderate-to-severe single-level DDD; at least 6 months failed conservative care.
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 QualCare policy.
How to submit
- Method: eviCore portal
- Portal: eviCore by Evernorth (Cigna MSK/Spine)
Sources & verification
- BindingSource — Cigna 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 QualCare require prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Yes. QualCare generally requires prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does QualCare require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization via eviCore (Cigna CMM-610). Age 18-60; single-level L3-S1; FDA-approved disc; no hybrid fusion; no facet ankylosis; moderate-to-severe single-level DDD; at least 6 months failed conservative care. Always confirm against the current QualCare policy.
How long does a QualCare prior authorization take?
Turnaround varies by plan and submission method. Check the QualCare portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Lumbar Spine) to QualCare?
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.