Does 22634 require prior authorization?

No, 22634 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 22634?

Medicare facility rate: $432.54. Non-facility rate: $432.54. Work RVU: 7.76.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

7.76

Facility

$432.54

Non-Facility

$432.54

Documentation must include provider office notes detailing preoperative medical optimization.
Documentation must include copies of medical consultations or clearances.
Documentation may include ASA status, Charlson Comorbidity Index score, or other validated surgical risk score to support the requested level of care.
Prior to level of care determination, the procedure must meet any applicable clinical appropriateness guideline.

Inpatient admission is medically necessary when current postoperative care requirements are of such intensity or duration that they cannot be met in an observation or outpatient setting.
Inpatient admission is medically necessary when anticipated postoperative care requirements cannot be met in an observational surgical setting due to complexity, duration, or extent of the planned procedure or substantial preoperative patient risk.
Inpatient admission is medically necessary when preoperative ASA status is ≥ IV (see Appendix).
Inpatient admission is medically necessary when distance from the nearest hospital emergency room poses a clinically significant risk for emergent post-operative complications.
Inpatient admission is medically necessary when there is an inability to establish clinically appropriate supervision and support within the patient’s home.
Cervical disc arthroplasty is considered medically necessary for the following indications:

CARELON-level-of-care-for-surgical-procedures-2025-11-15, Level of Care for Surgical Procedures

CARELON-spine-surgery-2024-10-20-for-anthem-bcbs-ohio-medicaid, Spine Surgery

CARELON-spine-surgery-2025-11-15-updated-2026-01-01, Spine Surgery

BCBSIL-SUR712.036, Lumbar Spinal Fusion

BCBSMT-SUR712.036

Ask Verity about documentation requirements, denial risks, or coverage in your state.