Payor
CareFirst Community Health Plan
Rubrica tracks 25 sourced coverage rules across 25 CPT codes for CareFirst Community Health Plan — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid. 1-state regional policy (sample: md).
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Every Rubrica record cites a specific CareFirst Community Health Plan 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
CareFirst Community Health Plan'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 |
| RFA | 4 | 4 | 4 | 0 |
| Decompression | 2 | 2 | 2 | 0 |
| Intradiscal | 2 | 2 | 2 | 0 |
| Regenerative | 2 | 0 | 0 | 2 |
| SI Fusion | 2 | 2 | 2 | 0 |
| SI Joint | 1 | 1 | 1 | 0 |
Top tracked procedures
First 15 CPT codes in the CareFirst Community Health Plan 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 |
27279 | SI Fusion — Minimally Invasive | Covered |
27280 | SI Fusion — Open | Covered |
62287 | Percutaneous Disc Decompression — Fluoroscopic | Covered |
62380 | Endoscopic Lumbar Decompression | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Covered |
62331 | MILD — Percutaneous Lumbar Decompression (with image guidance) | Covered |
0232T | PRP — Platelet Rich Plasma Injection | Not covered |
0779T | Percutaneous Tenotomy / Ultrasonic Debridement | Not covered |
See every policy for CareFirst Community Health Plan.
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