CPT 63052 · Decompression — Surgical
Decompression During Posterior Interbody Fusion — Lumbar (NEW 2026)
Laminectomy, facetectomy, or foraminotomy during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure). New CPT for 2026. Use with 22630, 22632, 22633, 22634.
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Rubrica tracks payor coverage for CPT 63052 (Decompression During Posterior Interbody Fusion — Lumbar (NEW 2026)) across 18 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 63052
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Anthem BCBS | Covered | Prior auth |
| Cigna | Covered | Prior auth |
| Cigna Medicare / HealthSpring | Covered | Prior auth |
| Humana Commercial | Covered | Prior auth |
| Humana Medicare Advantage | Covered | Prior auth |
| Medicare (CGS MAC) | Covered | Prior auth |
| Medicare (FCSO MAC) | Covered | Prior auth |
| Medicare (NGS MAC) | Covered | Prior auth |
| Medicare (Noridian JF MAC) | Covered | Prior auth |
| Medicare (Novitas MAC) | Covered | Prior auth |
Coverage themes for CPT 63052
Common patterns across the 18 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥12 weeks of conservative care before approving 63052.
15 of 18 payors require imaging concordance documentation.
Of the 18 payors with coverage records for CPT 63052, 15 require prior authorization, 3 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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