Payor
Florida Medicaid
Rubrica tracks 100 sourced coverage rules across 100 CPT codes for Florida Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: fl).
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Every Rubrica record cites a specific Florida Medicaid 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
Florida Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Diagnostic | 14 | 13 | 4 | 1 |
| Peripheral Nerve Block | 11 | 11 | 0 | 0 |
| Intradiscal | 10 | 10 | 10 | 0 |
| Intrathecal Pump | 10 | 10 | 6 | 0 |
| Botulinum Toxin | 9 | 9 | 9 | 0 |
| Peripheral Joint/Tendon | 5 | 5 | 0 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| HCPCS Drug | 4 | 4 | 4 | 0 |
| Other Procedure | 4 | 3 | 3 | 0 |
| SCS | 4 | 4 | 2 | 0 |
| SI Joint | 4 | 4 | 4 | 2 |
| Sympathetic | 4 | 4 | 4 | 0 |
Top tracked procedures
First 15 CPT codes in the Florida Medicaid catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
27447 | Total Knee Arthroplasty (TKA) | Covered |
27130 | Total Hip Arthroplasty (THA) | Covered |
23472 | Total Shoulder Arthroplasty (TSA / Reverse TSA) | Covered |
29827 | Arthroscopic Rotator Cuff Repair | Covered |
29888 | Arthroscopic ACL Reconstruction | Covered |
22551 | ACDF — Anterior Cervical Discectomy and Fusion | Covered |
22612 | PLF — Posterior Lumbar Fusion (Posterolateral) | Covered |
22558 | ALIF — Anterior Lumbar Interbody Fusion | Covered |
63030 | Laminotomy with Disc Excision — Lumbar | Covered |
63047 | Laminectomy with Facetectomy and Foraminotomy — Lumbar | Covered |
0200T | Percutaneous sacroiliac joint arthrocentesis, with injection | Covered |
0201T | Percutaneous sacroiliac joint arthrocentesis, with injection, each additional joint | Covered |
0232T | Injection, platelet-rich plasma (PRP), any site, including image guidance, harvesting and preparation when performed | Not covered |
0275T | Resequencing and analysis of mitochondrial DNA to detect heteroplasmic variants | Not covered |
0627T | Percutaneous injection of autologous adipose-derived regenerative cells | Not covered |
0629T | Percutaneous injection, allograft/autograft tissue substitute (including donor harvesting if autograft) | Not covered |
0779T | Laser-assisted uvulopalatoplasty (LAUP) (excluding, carbon dioxide or argon laser) | Not covered |
11980 | Subcutaneous hormone pellet implantation | Covered |
20526 | Injection, therapeutic (including joint), bursa, ganglion cyst (aspiration), or baker's cyst; any size | Covered |
20552 | Injection, single tendon sheath, or ligament, aponeurosis (e.g., plantar fascia) | Covered |
20553 | Injection, single tendon sheath, or ligament, aponeurosis (e.g., plantar fascia); each additional injection site | Covered |
20610 | Arthrocentesis, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance | Covered |
20611 | Arthrocentesis, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); with ultrasound guidance, including image documentation | Covered |
22510 | Percutaneous posterolateral interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF), initial vertebral level | Covered |
22511 | Percutaneous posterolateral interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF), each additional vertebral level | Covered |
See every policy for Florida Medicaid.
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