Rubrica

Payor

BCBS Tennessee

Rubrica tracks 63 sourced coverage rules across 63 CPT codes for BCBS Tennessee — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 1-state regional policy (sample: tn).

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63
Sourced rules
63
CPT codes tracked
49
Covered (78%)
56
Prior auth required

Every Rubrica record cites a specific BCBS Tennessee 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 Tennessee's coverage stance across procedure categories tracked in the Rubrica catalog.

CategoryRulesCoveredPrior authInvestigational
Other Procedure2222190
Epidural6660
Facet/MBB6460
Decompression4341
RFA4440
ViaDisc4044
Vertebral Augmentation3330
BVN Ablation2022
Interspinous Spacer2002
MILD2002
SCS2220
SI Joint2220

Top tracked procedures

First 15 CPT codes in the BCBS Tennessee catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.

CPTProcedureCoverage
62321Interlaminar ESI — Cervical/ThoracicCovered
62323Interlaminar ESI — Lumbar/SacralCovered
64479Transforaminal ESI — Cervical/Thoracic (1st level)Covered
64480Transforaminal ESI — Cervical/Thoracic (each additional level)Covered
64483Transforaminal ESI — Lumbar/Sacral (1st level)Covered
64484Transforaminal ESI — Lumbar/Sacral (each additional level)Covered
64490Facet/MBB — Cervical/Thoracic (1st level)Covered
64491Facet/MBB — Cervical/Thoracic (2nd level)Covered
64492Facet/MBB — Cervical/Thoracic (3rd+ level)Not covered
64493Facet/MBB — Lumbar (1st level)Covered
64494Facet/MBB — Lumbar (2nd level)Covered
64495Facet/MBB — Lumbar (3rd+ level)Not covered
64633RFA — Cervical/Thoracic (1st level)Covered
64634RFA — Cervical/Thoracic (each additional level)Covered
64635RFA — Lumbar (1st level)Covered
64636RFA — Lumbar (each additional level)Covered
27096SI Joint Injection (with image guidance)Covered
G0260SI Joint Injection — ASC HCPCS codeCovered
27279Minimally Invasive SI Joint Fusion (titanium triangular implants)Covered
63650Spinal Cord Stimulator — Percutaneous Trial Electrode PlacementCovered
63685Spinal Cord Stimulator — Permanent IPG ImplantationCovered
22513Percutaneous Vertebral Augmentation — ThoracicCovered
22514Percutaneous Vertebral Augmentation — LumbarCovered
22515Percutaneous Vertebral Augmentation — Each Additional LevelCovered
62330Image-Guided Minimally Invasive Lumbar Decompression (MILD) — 1st InterspaceNot covered

See every policy for BCBS Tennessee.

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