Payor
Horizon BCBS NJ
Rubrica tracks 63 sourced coverage rules across 63 CPT codes for Horizon BCBS NJ — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 1-state regional policy (sample: nj).
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Every Rubrica record cites a specific Horizon BCBS NJ 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
Horizon BCBS NJ's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Other Procedure | 15 | 15 | 14 | 0 |
| ESI | 6 | 6 | 6 | 0 |
| Facet/MBB | 6 | 6 | 6 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| RFA | 4 | 4 | 4 | 0 |
| ViaDisc | 4 | 0 | 4 | 4 |
| Vertebral Augmentation | 3 | 3 | 3 | 0 |
| BVN ablation | 2 | 0 | 2 | 2 |
| Decompression | 2 | 1 | 2 | 1 |
| Interspinous Spacer | 2 | 0 | 2 | 2 |
| MILD | 2 | 0 | 2 | 2 |
| SCS | 2 | 2 | 2 | 0 |
Top tracked procedures
First 15 CPT codes in the Horizon BCBS NJ catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
62321 | Interlaminar ESI - Cervical/Thoracic with imaging | Covered |
62323 | Interlaminar ESI - Lumbar/Sacral with imaging | Covered |
64479 | TFESI - Cervical/Thoracic, single level | Covered |
64480 | TFESI - Cervical/Thoracic, additional level (add-on) | Covered |
64483 | TFESI - Lumbar/Sacral, single level | Covered |
64484 | TFESI - Lumbar/Sacral, additional level (add-on) | Covered |
64490 | Paravertebral facet joint injection/MBB — Cervical/Thoracic, single level | Covered |
64491 | Paravertebral facet joint injection — Cervical/Thoracic, second level (add-on) | Covered |
64492 | Paravertebral facet joint injection — Cervical/Thoracic, third+ levels (add-on) | Covered |
64493 | Paravertebral facet joint injection/MBB — Lumbar, single level | Covered |
64494 | Paravertebral facet joint injection — Lumbar, second level (add-on) | Covered |
64495 | Paravertebral facet joint injection — Lumbar, third+ levels (add-on) | Covered |
64633 | RFA — Cervical/Thoracic facet, single joint | Covered |
64634 | RFA — Cervical/Thoracic facet, additional joint (add-on) | Covered |
64635 | RFA — Lumbar/Sacral facet, single joint | Covered |
64636 | RFA — Lumbar/Sacral facet, additional joint (add-on) | Covered |
27096 | Sacroiliac joint injection | Covered |
G0260 | Sacroiliac joint injection (HCPCS - ASC/facility) | Covered |
27279 | Minimally invasive sacroiliac joint fusion (transfixing device) | Covered |
63650 | SCS — Percutaneous trial lead placement | Covered |
63685 | SCS — Permanent IPG/receiver insertion | Covered |
22513 | Vertebral augmentation/kyphoplasty — Thoracic, single level | Covered |
22514 | Vertebral augmentation/kyphoplasty — Lumbar, single level | Covered |
22515 | Vertebral augmentation/kyphoplasty — additional level (add-on) | Covered |
62330 | MILD — Percutaneous lumbar decompression (no image guidance) — new 2026 CPT | Not covered |
See every policy for Horizon BCBS NJ.
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