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BCBS MN Code List BlueCross BlueShield of MN: Spine Surgery Comprehensive CPT Code List Category CPT® Code CPT® Code Description Requires PA Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition Spine Surgery 20930 Yes to code for primary procedure) Spine Surgery 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Yes Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar Spine Surgery 20936 Yes fragments) obtained from same incision (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial Spine Surgery 20937 Yes incision) (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through Spine Surgery 20938 Yes separate skin or fascial incision) (List separately in addition to code for primary procedure) Spine Surgery 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) Yes Spine Surgery 20975 Electrical stimulation to aid bone healing; invasive (operative) Yes Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral Spine Surgery 22510 Yes Injection, inclusive of all imaging guidance; cervicothoracic Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral Spine Surgery 22511 Yes Injection, inclusive of all imaging guidance; lumbosacral Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral Spine Surgery 22512 Injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List Yes separately in addition to code for primary procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included Spine Surgery 22513 when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, Yes inclusive of all imaging guidance; thoracic Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included Spine Surgery 22514 when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, Yes inclusive of all imaging guidance; lumbar Effective: 1/1/2020 Category CPT® Code CPT® Code Description Requires PA Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, Spine Surgery 22515 Yes inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for Spine Surgery 22533 Yes decompression); lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for Spine Surgery 22534 decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for Yes primary procedure) Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and Spine Surgery 22551 Yes decompression of spinal cord and/or nerve roots; cervical below C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and Spine Surgery 22552 decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately Yes in addition to code for separate procedure) Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for Spine Surgery 22554 Yes decompression); cervical below C2 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for Spine Surgery 22558 Yes decompression); lumbar Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for Spine Surgery 22585 Yes decompression); each additional interspace (List separately in addition to code for primary procedure) Spine Surgery 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment Yes Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when Spine Surgery 22612 Yes performed) Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately Spine Surgery 22614 Yes in addition to code for primary procedure) Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace Spine Surgery 22630 Yes (other than for decompression), single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace Spine Surgery 22632 (other than for decompression), single interspace; each additional interspace (List separately in addition to code Yes for primary procedure) Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including Spine Surgery 22633 laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single Yes interspace and segment; lumbar Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single Spine Surgery 22634 Yes interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) Spine Surgery 22841 Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) Yes Effective: 1/1/2020 Category CPT® Code CPT® Code Description Requires PA Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 Spine Surgery 22842 Yes to 6 vertebral segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 Spine Surgery 22843 Yes to 12 vertebral segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); Spine Surgery 22844 Yes 13 or more vertebral segments (List separately in addition to code for primary procedure) Spine Surgery 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) Yes Spine Surgery 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) Yes Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary Spine Surgery 22847 Yes procedure) Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List Spine Surgery 22848 Yes separately in addition to code for primary procedure) Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation Spine Surgery 22853 for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with Yes interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) Spine Surgery 22854 Yes (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation Spine Surgery 22856 (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, Yes cervical Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than Spine Surgery 22857 Yes for decompression), single interspace, lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation Spine Surgery 22858 (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, Yes cervical (List separately in addition to code for primary procedure) Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to Spine Surgery 22859 intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List Yes separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; Spine Surgery 22861 Yes cervical Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; Spine Surgery 22862 Yes lumbar Insertion of interlaminar/interspinous
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