Payor
Blue Cross Blue Shield of North Dakota
Rubrica tracks 15 sourced coverage rules across 15 CPT codes for Blue Cross Blue Shield of North Dakota — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 1-state regional policy (sample: nd).
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Every Rubrica record cites a specific Blue Cross Blue Shield of North Dakota 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
Blue Cross Blue Shield of North Dakota's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Epidural | 4 | 0 | 0 | 0 |
| Vertebral Augmentation | 4 | 0 | 0 | 0 |
| Peripheral Joint/Tendon | 3 | 0 | 0 | 0 |
| Facet/MBB | 1 | 0 | 0 | 0 |
| HCPCS Drug | 1 | 0 | 0 | 0 |
| SI Fusion | 1 | 0 | 0 | 0 |
| Trigger Point | 1 | 0 | 0 | 0 |
Top tracked procedures
First 15 CPT codes in the Blue Cross Blue Shield of North Dakota catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
62321 | Interlaminar ESI — Cervical/Thoracic | Not covered |
62323 | Interlaminar ESI — Lumbar | Not covered |
64479 | TFESI — Cervical/Thoracic (1st level) | Not covered |
64483 | TFESI — Lumbar/Sacral (1st level) | Not covered |
64490 | Facet/MBB — Cervical/Thoracic (1st level) | Not covered |
20526 | Carpal Tunnel Injection | Not covered |
20552 | Trigger Point Injection — 1 or 2 muscles | Not covered |
20610 | Major Joint Injection (without US/Fluoro) | Not covered |
20611 | Major Joint Injection (with US) | Not covered |
J7321 | Hyaluronate Injection (Supartz/Hyalgan/VISCO-3) | Not covered |
27279 | SI Fusion — Minimally Invasive | Not covered |
22510 | Vertebroplasty — Cervicothoracic (1st level) | Not covered |
22511 | Vertebroplasty — Lumbosacral (1st level) | Not covered |
22513 | Kyphoplasty — Thoracic (1st level) | Not covered |
22514 | Kyphoplasty — Lumbar (1st level) | Not covered |
See every policy for Blue Cross Blue Shield of North Dakota.
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