Payor
Highmark BCBS
Rubrica tracks 77 sourced coverage rules across 77 CPT codes for Highmark BCBS — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 4-state regional policy (sample: de, ny, pa, wv).
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Every Rubrica record cites a specific Highmark BCBS 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
Highmark BCBS's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Spine Surgery | 10 | 9 | 9 | 1 |
| Epidural | 6 | 6 | 6 | 0 |
| Facet/MBB | 6 | 6 | 6 | 0 |
| Vertebral Augmentation | 5 | 5 | 5 | 0 |
| Arthroplasty — Knee | 4 | 4 | 4 | 0 |
| Interspinous Device | 4 | 4 | 4 | 0 |
| Intrathecal Pump | 4 | 4 | 4 | 0 |
| PNS | 4 | 0 | 4 | 0 |
| RFA | 4 | 4 | 4 | 0 |
| SCS | 4 | 4 | 4 | 0 |
| ViaDisc | 4 | 0 | 4 | 4 |
| Arthroscopy — Knee | 3 | 3 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the Highmark BCBS catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
63661 | SCS — Lead Revision/Removal (percutaneous) | Covered |
63688 | SCS — Generator Revision/Removal | Covered |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Not covered |
64555 | PNS — Percutaneous Lead Trial/Placement | Not covered |
64580 | PNS — Open Electrode Placement (neuromuscular) | Not covered |
64590 | PNS — Generator Insertion | Not covered |
64595 | PNS — Generator Revision/Removal | Not covered |
62380 | Endoscopic Lumbar Decompression | Not covered |
0200T | Sacroplasty — Unilateral | Covered |
0201T | Sacroplasty — Bilateral | Covered |
27280 | SI Fusion — Open | Covered |
62362 | Pain Pump — Programmable Pump Insertion | Covered |
62365 | Pain Pump — Removal | Covered |
95990 | Pain Pump — Refill (by clinician) | Covered |
95991 | Pain Pump — Refill w/ Reprogramming | Covered |
22869 | MinuteMan/Inspan — Interspinous Fixation (1st level) | Covered |
22870 | MinuteMan/Inspan — Interspinous Fixation (add'l) | Covered |
62287 | Percutaneous Disc Decompression — Fluoroscopic | Not covered |
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 |
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