Rubrica

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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63
Sourced rules
63
CPT codes tracked
51
Covered (81%)
61
Prior auth required

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.

CategoryRulesCoveredPrior authInvestigational
Other Procedure1515140
ESI6660
Facet/MBB6660
Spine Surgery5550
RFA4440
ViaDisc4044
Vertebral Augmentation3330
BVN ablation2022
Decompression2121
Interspinous Spacer2022
MILD2022
SCS2220

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.

CPTProcedureCoverage
62321Interlaminar ESI - Cervical/Thoracic with imagingCovered
62323Interlaminar ESI - Lumbar/Sacral with imagingCovered
64479TFESI - Cervical/Thoracic, single levelCovered
64480TFESI - Cervical/Thoracic, additional level (add-on)Covered
64483TFESI - Lumbar/Sacral, single levelCovered
64484TFESI - Lumbar/Sacral, additional level (add-on)Covered
64490Paravertebral facet joint injection/MBB — Cervical/Thoracic, single levelCovered
64491Paravertebral facet joint injection — Cervical/Thoracic, second level (add-on)Covered
64492Paravertebral facet joint injection — Cervical/Thoracic, third+ levels (add-on)Covered
64493Paravertebral facet joint injection/MBB — Lumbar, single levelCovered
64494Paravertebral facet joint injection — Lumbar, second level (add-on)Covered
64495Paravertebral facet joint injection — Lumbar, third+ levels (add-on)Covered
64633RFA — Cervical/Thoracic facet, single jointCovered
64634RFA — Cervical/Thoracic facet, additional joint (add-on)Covered
64635RFA — Lumbar/Sacral facet, single jointCovered
64636RFA — Lumbar/Sacral facet, additional joint (add-on)Covered
27096Sacroiliac joint injectionCovered
G0260Sacroiliac joint injection (HCPCS - ASC/facility)Covered
27279Minimally invasive sacroiliac joint fusion (transfixing device)Covered
63650SCS — Percutaneous trial lead placementCovered
63685SCS — Permanent IPG/receiver insertionCovered
22513Vertebral augmentation/kyphoplasty — Thoracic, single levelCovered
22514Vertebral augmentation/kyphoplasty — Lumbar, single levelCovered
22515Vertebral augmentation/kyphoplasty — additional level (add-on)Covered
62330MILD — Percutaneous lumbar decompression (no image guidance) — new 2026 CPTNot covered

See every policy for Horizon BCBS NJ.

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