Payor
Georgia Medicaid
Rubrica tracks 101 sourced coverage rules across 101 CPT codes for Georgia Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: ga).
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Every Rubrica record cites a specific Georgia 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
Georgia Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Diagnostic | 18 | 18 | 2 | 0 |
| Peripheral Nerve Block | 11 | 11 | 1 | 0 |
| Intradiscal | 9 | 9 | 9 | 0 |
| Decompression | 7 | 7 | 7 | 0 |
| Facet/MBB | 7 | 7 | 2 | 0 |
| Epidural | 6 | 6 | 0 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| HCPCS Drug | 4 | 4 | 4 | 0 |
| Intrathecal Pump | 4 | 4 | 2 | 0 |
| Botulinum Toxin | 3 | 3 | 3 | 0 |
| SCS | 3 | 3 | 2 | 0 |
| Sympathetic | 3 | 3 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the Georgia 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 stabilization | Covered |
0201T | Percutaneous sacroiliac joint stabilization - additional iliac screw | Covered |
0232T | Injection of platelet-rich plasma into intra-articular joint | Covered |
0275T | Percutaneous lumbosacral plexus block | Covered |
0627T | Percutaneous vertebral body augmentation - thoracic or lumbar | Covered |
0629T | Percutaneous vertebral augmentation - additional vertebra | Covered |
0779T | Percutaneous intradiscal electrothermal annuloplasty | Covered |
11980 | Subcutaneous hormone pellet implantation | Covered |
20526 | Injection, therapeutic (including guiding fluoroscopy) - lower extremity | Covered |
20552 | Injection of calcaneal spur (plantar fascia) | Covered |
20553 | Injection, single trigger point | Covered |
20610 | Arthrocentesis - major joint | Covered |
20611 | Arthrocentesis - major joint with therapeutic injection | Covered |
22510 | Posterior lumbar interbody fusion - single interspace | Covered |
22511 | Posterior lumbar interbody fusion - each additional interspace | Covered |
See every policy for Georgia Medicaid.
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