Interventional Spine · Policy Library
Interventional spine, by the rule.
Part of the Rubrica clinical policy library — the largest sourced collection in the specialty. Every payor coverage rule for interventional spine procedures: interlaminar and transforaminal epidural steroid injections, facet joint injections and medial branch blocks, radiofrequency ablation, sacroiliac joint injections, kyphoplasty, spinal cord stimulation, and more. Each record carries the verbatim policy text, the policy number, and the last-reviewed date.
Free with practitioner sign-in — magic-link email auth, no credit card.
Built for interventional pain physicians, fellowship-trained pain anesthesiologists, and the prior-authorization staff who keep their schedules running. We track every Medicare LCD, every Aetna CPB, every BCBS regional medical policy, every Cigna CCP, every Carelon and eviCore guideline that touches the IS catalog.
Top procedures by payor coverage
Eight procedures with the broadest payor coverage in this specialty. Click through any of them in the live app for the full coverage breakdown.
| CPT | Procedure | Coverage breadth |
|---|---|---|
27279 | SI Fusion — Minimally Invasive | 137 payors |
22513 | Kyphoplasty — Thoracic (1st level) | 136 payors |
22514 | Kyphoplasty — Lumbar (1st level) | 136 payors |
62321 | Interlaminar ESI — Cervical/Thoracic | 128 payors |
62323 | Interlaminar ESI — Lumbar | 127 payors |
64479 | TFESI — Cervical/Thoracic (1st level) | 127 payors |
64483 | TFESI — Lumbar/Sacral (1st level) | 127 payors |
64490 | Facet/MBB — Cervical/Thoracic (1st level) | 126 payors |
Full catalog at /library — 107 procedures, 107 unique CPTs.
Payors tracked
Top 12 payors by number of rules in this specialty. Each rule is sourced to a specific policy document with last-reviewed date.
Plus 131 more payors. Full per-payor drill-down at #payor=<name>.
Coverage Q&A
Common prior-auth questions for this specialty. Each answer is grounded in a specific policy document; live decisions are available at rubricamedical.com/#app.
Lumbar transforaminal ESI prior auth (CPT 64483)
Across all major commercial payors, ≥6 weeks conservative care + imaging concordance is the standard. Aetna CPB 0722 and Cigna eviCore CMM-200 are the most-cited references.
Lumbar facet RFA (CPT 64635)
Every payor we track requires a positive diagnostic medial branch block before therapeutic RFA. The relief-threshold percentage varies — Medicare LCDs accept ≥80%, while older commercial policies still cite ≥50%. Oscar Health updated to ≥80% in CG047 v9, captured in our 2026-05-10 weekly swarm.
Sacroiliac joint injection (CPT 27096)
Coverage is broad but criteria are tightening. Most BCBS regionals and Medicare MACs require failed conservative care plus a positive Fortin finger test or 3-of-5 provocation maneuvers.
Spinal cord stimulator trial (CPT 63650)
Universal: psychological clearance, ≥6 months pain, failure of multimodal therapy, and successful trial relief documentation before permanent implant (63685).
How we encode coverage
Every record is keyed by payor + CPT + region, sourced to a public policy
document, dated by last-reviewed date, and tagged with verbatim source quotes
where available. Records older than 18 months are flagged stale; records that
couldn't be authoritatively confirmed are flagged needs_verification
and surfaced behind a warning.
The decision engine compares clinical context against criteria sub-objects — conservative care, imaging concordance, prior-procedure documentation, and repeat-procedure thresholds — and returns a likelihood plus a 0–100 denial-risk score with the top three drivers. Read the full methodology at /methodology.
Run a real check.
Pick a payor, enter the clinical context, get a sourced answer with denial risk and the missing documentation list — in seconds.
Run a check →