Pain Management · Policy Library
Pain management coverage, cited to the policy.
Part of the Rubrica clinical policy library — the largest sourced collection in interventional pain. Every coverage rule for chronic-pain procedures: transforaminal and interlaminar ESI, facet and medial branch blocks, radiofrequency ablation, neuromodulation, sympathetic blocks. Built for interventional pain physicians, pain anesthesiologists, and the operations teams behind every clinic. Every rule sourced, dated, and citable.
Free with practitioner sign-in — magic-link email auth, no credit card.
Chronic pain practice runs on prior auth. Whether you're an interventional pain physician at an ASC or a pain anesthesiologist running a hospital-based clinic, Rubrica answers "is this covered, and what does the payor want" in seconds — with verbatim policy text and a denial-risk score.
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.
Trigger point injection (CPT 20552 / 20553)
Universal coverage but session caps vary. Most BCBS plans cap at 4 visits per 12 months; Medicare LCDs allow more if functional improvement is documented.
Peripheral nerve block (occipital, intercostal)
Coverage broad for diagnostic and therapeutic; the proposed multi-MAC LCD on chronic peripheral nerve blocks (DL40265) is a 2026 watch item.
Botulinum toxin for chronic migraine (CPT 64615)
Aetna, Cigna, UHC, all major BCBS plans cover with PA + IHS chronic-migraine criteria. Strict frequency limit (every 12 weeks).
Intrathecal pump trial and refill (CPT 62370 / 62367)
Trial and permanent implant covered with neuromodulation criteria; refill (95990 / 95991) covered universally with appropriate documentation.
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 →