Payor
BCBS Federal Employee Program
Rubrica tracks 80 sourced coverage rules across 80 CPT codes for BCBS Federal Employee Program — 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 BCBS Federal Employee Program 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
BCBS Federal Employee Program's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Other Procedure | 22 | 22 | 22 | 0 |
| Decompression | 6 | 3 | 6 | 2 |
| Epidural | 6 | 6 | 0 | 0 |
| Facet/MBB | 6 | 6 | 0 | 0 |
| Vertebral Augmentation | 5 | 5 | 2 | 0 |
| Interspinous Device | 4 | 4 | 4 | 0 |
| Intrathecal Pump | 4 | 4 | 4 | 0 |
| PNS | 4 | 0 | 4 | 0 |
| RFA | 4 | 4 | 0 | 0 |
| SCS | 4 | 4 | 4 | 0 |
| ViaDisc | 4 | 0 | 4 | 4 |
| SI Fusion | 3 | 3 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the BCBS Federal Employee Program 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 |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Not covered |
64555 | PNS — Percutaneous Lead Trial/Placement | Not covered |
64580 | PNS — Open Electrode Placement (neuromuscular) | Not covered |
64590 | PNS — Generator Insertion | Not covered |
64595 | PNS — Generator Revision/Removal | 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 |
62321 | Interlaminar ESI — Cervical/Thoracic with imaging | Covered |
62323 | Interlaminar ESI — Lumbar/Sacral with imaging | Covered |
64479 | Transforaminal ESI — Cervical/Thoracic, single level | Covered |
64480 | Transforaminal ESI — Cervical/Thoracic, each additional level (add-on) | Covered |
64483 | Transforaminal ESI — Lumbar/Sacral, single level | Covered |
64484 | Transforaminal ESI — Lumbar/Sacral, each additional level (add-on) | Covered |
64490 | Cervical/Thoracic facet joint injection or MBB — single level | Covered |
64491 | Cervical/Thoracic facet joint injection or MBB — second level (add-on) | Covered |
64492 | Cervical/Thoracic facet joint injection or MBB — third and any additional level(s) (add-on) | Covered |
See every policy for BCBS Federal Employee Program.
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