Payor
BCBS Michigan
Rubrica tracks 62 sourced coverage rules across 62 CPT codes for BCBS Michigan — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 1-state regional policy (sample: mi).
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Every Rubrica record cites a specific BCBS Michigan 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 Michigan's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Epidural | 6 | 6 | 6 | 0 |
| Facet/MBB | 6 | 6 | 6 | 0 |
| Other Procedure | 5 | 5 | 5 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| Arthroplasty — Knee | 4 | 4 | 4 | 0 |
| RFA | 4 | 4 | 4 | 0 |
| ViaDisc | 4 | 0 | 4 | 4 |
| Arthroscopy — Knee | 3 | 3 | 3 | 0 |
| Vertebral Augmentation | 3 | 3 | 3 | 0 |
| Arthroplasty — Hip | 2 | 2 | 2 | 0 |
| BVN Ablation | 2 | 2 | 2 | 0 |
| Decompression | 2 | 1 | 2 | 1 |
Top tracked procedures
First 15 CPT codes in the BCBS Michigan catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
62321 | Interlaminar ESI — Cervical/Thoracic | Covered |
62323 | Interlaminar ESI — Lumbar | Covered |
64479 | TFESI — Cervical/Thoracic (1st level) | Covered |
64480 | TFESI — Cervical/Thoracic (add'l level) | Covered |
64483 | TFESI — Lumbar/Sacral (1st level) | Covered |
64484 | TFESI — Lumbar/Sacral (add'l level) | Covered |
64490 | Facet/MBB — Cervical/Thoracic (1st level) | Covered |
64491 | Facet/MBB — Cervical/Thoracic (2nd level) | Covered |
64492 | Facet/MBB — Cervical/Thoracic (3rd+ level) | Covered |
64493 | Facet/MBB — Lumbar/Sacral (1st level) | Covered |
64494 | Facet/MBB — Lumbar/Sacral (2nd level) | Covered |
64495 | Facet/MBB — Lumbar/Sacral (3rd+ level) | Covered |
64633 | RFA — Cervical/Thoracic Facet (1st level) | Covered |
64634 | RFA — Cervical/Thoracic Facet (add'l level) | Covered |
64635 | RFA — Lumbar/Sacral Facet (1st level) | Covered |
64636 | RFA — Lumbar/Sacral Facet (add'l level) | Covered |
27096 | Sacroiliac Joint Injection (CPT) | Covered |
G0260 | SIJ Injection (HCPCS) | Covered |
27279 | Minimally Invasive SI Joint Fusion | Covered |
63650 | SCS — Percutaneous Trial | Covered |
63685 | SCS — Permanent Implant (IPG) | Covered |
22513 | Kyphoplasty — Thoracic (1st level) | Covered |
22514 | Kyphoplasty — Lumbar (1st level) | Covered |
22515 | Kyphoplasty — Add'l Level | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Covered |
See every policy for BCBS Michigan.
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