MUSCULOSKELETAL (MSK) SPINE
Defines bundling, add-on code reporting, modifier use, and documentation requirements for spine procedures billed to Priority Health across Commercial, Medicare, and Medicaid lines.
Added 'Disclaimer' section.
Policy was reviewed with no updates on Feb. 17, 2026.
Spine procedure billing and payment rules
Spine procedure billing criteria
Billing and payment rules for spine procedures, including bundled services, add-on code reporting, modifier use, and required documentation.
ALL of the following
ALL of the following
- Bone marrow aspiration procedures (38220, 38230, 38232) are always included and not paid separately when done with spinal osteotomy, vertebral fracture repair, spinal arthrodesis, spinal fusion, laminectomy, spinal decompression, or vertebral corpectomy.
- Spinal exploration (22830) is bundled when performed in the same anatomic area as another spinal procedure.
- Intraoperative neurophysiology testing (95940, 95941, G0453) is bundled when performed by the same physician during the spinal procedure.
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