Prior Auth Required

22843 - Benefit Policy Manual Chapter 1 –

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceBenefit Policy Manual Chapter 1 –
Procedure / Service Description

Intradiscal Procedures (TIPs) NCD - for Pain Management; Psychiatric 22632-22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830 Inpatient Hospitalization; Medicare Benefit Policy Manual Chapter 1 – 22840-22849, 22853, 22854, 22856-22859, 22861, 22862, 22867-22870, 22899, Inpatient Hospital Services; 27279, 27280, 62287, 62380, 63001, 63003, 63005, 63011, 63012, 63015-63017

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.