Payor
Anthem BCBS
Rubrica tracks 289 sourced coverage rules across 289 CPT codes for Anthem BCBS — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. National policy.
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Every Rubrica record cites a specific Anthem BCBS policy document with last-reviewed date and (where available) verbatim source text. Aggregate coverage breakdown by procedure category is shown below; full payor-specific criteria require sign-in.
Coverage by category
Anthem BCBS's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Arthroscopy | 48 | 48 | 48 | 0 |
| Procedure (templated) | 47 | 47 | 47 | 0 |
| Spinal Decompression | 28 | 28 | 26 | 0 |
| Spinal Fusion | 19 | 19 | 14 | 0 |
| Trauma / Fracture | 16 | 16 | 0 | 0 |
| Joint Arthroplasty | 11 | 11 | 11 | 0 |
| Diagnostic — EMG/NCS | 8 | 8 | 0 | 0 |
| Spine Surgery | 8 | 7 | 8 | 1 |
| Other Procedure | 7 | 7 | 7 | 0 |
| Epidural | 6 | 6 | 6 | 0 |
| Facet/MBB | 6 | 6 | 6 | 0 |
| Intradiscal | 6 | 0 | 6 | 4 |
Top tracked procedures
First 15 CPT codes in the Anthem BCBS catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
63661 | SCS — Lead Revision/Removal (percutaneous) | Covered |
63688 | SCS — Generator Revision/Removal | Covered |
64555 | PNS — Percutaneous Lead Trial/Placement | Covered |
64580 | PNS — Open Electrode Placement (neuromuscular) | Covered |
64590 | PNS — Generator Insertion | Covered |
64595 | PNS — Generator Revision/Removal | Covered |
62380 | Endoscopic Lumbar Decompression | Not covered |
0200T | Sacroplasty — Unilateral | Covered |
0201T | Sacroplasty — Bilateral | Covered |
27280 | SI Fusion — Open | Covered |
62362 | Pain Pump — Programmable Pump Insertion | Covered |
62365 | Pain Pump — Removal | Covered |
95990 | Pain Pump — Refill (by clinician) | Covered |
95991 | Pain Pump — Refill w/ Reprogramming | Covered |
22869 | MinuteMan/Inspan — Interspinous Fixation (1st level) | Covered |
22870 | MinuteMan/Inspan — Interspinous Fixation (add'l) | Covered |
62287 | Percutaneous Disc Decompression — Fluoroscopic | Not covered |
62321 | Interlaminar Cervical/Thoracic Epidural Steroid Injection | Covered |
62323 | Interlaminar Lumbar/Sacral Epidural Steroid Injection | Covered |
64479 | Transforaminal Cervical/Thoracic Epidural Steroid Injection (1st level) | Covered |
64480 | Transforaminal Cervical/Thoracic ESI (additional level) | Covered |
64483 | Transforaminal Lumbar/Sacral ESI (1st level) | Covered |
64484 | Transforaminal Lumbar/Sacral ESI (additional level) | Covered |
64490 | Cervical/Thoracic Facet/MBB (1st level) | Covered |
64493 | Lumbar Facet/MBB (1st level) | Covered |
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