TRICARE Artificial Intervertebral Disc Surgery (Lumbar Spine) prior authorization requirements (2026)
What TRICARE generally requires to approve Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865), for tricare plans. Prior authorization requirements vary by plan. Confirm with TRICARE for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
Medical-necessity criteria TRICARE generally applies
Covered (proven) for single-level lumbar disc (22857) using an FDA-approved disc for single-level lumbar DDD in patients who failed conservative treatment (TRICARE adopted this retroactive to 11/16/2017; the older "unproven" manual entry is superseded). Multilevel lumbar TDR remains unproven. Verify authorization with the regional contractor.
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 TRICARE policy.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 6.1 (single-level lumbar TDR covered) · effective 2017-11-16.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 TRICARE require prior authorization for Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Prior authorization requirements vary by plan. Confirm with TRICARE for Artificial Intervertebral Disc Surgery (Lumbar Spine) (CPT 22857, 22860, 22862, 22865).
What does TRICARE require to approve Artificial Intervertebral Disc Surgery (Lumbar Spine)?
Covered (proven) for single-level lumbar disc (22857) using an FDA-approved disc for single-level lumbar DDD in patients who failed conservative treatment (TRICARE adopted this retroactive to 11/16/2017; the older "unproven" manual entry is superseded). Multilevel lumbar TDR remains unproven. Verify authorization with the regional contractor. Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Artificial Intervertebral Disc Surgery (Lumbar Spine) to TRICARE?
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.