Payor
Humana Commercial
Rubrica tracks 233 sourced coverage rules across 233 CPT codes for Humana Commercial — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. National policy.
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Every Rubrica record cites a specific Humana Commercial 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
Humana Commercial's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Arthroscopy | 48 | 48 | 48 | 0 |
| Procedure (templated) | 47 | 47 | 47 | 0 |
| Spinal Decompression | 28 | 28 | 26 | 0 |
| Spinal Fusion | 19 | 19 | 14 | 0 |
| Trauma / Fracture | 16 | 16 | 0 | 0 |
| Joint Arthroplasty | 11 | 11 | 11 | 0 |
| Diagnostic — EMG/NCS | 8 | 8 | 0 | 0 |
| Epidural | 6 | 6 | 6 | 0 |
| Peripheral Nerve Block | 5 | 5 | 3 | 0 |
| Chemodenervation | 4 | 4 | 4 | 0 |
| Sympathetic Block | 4 | 4 | 4 | 0 |
| Cartilage Restoration | 3 | 3 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the Humana Commercial catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
22867 | Vertiflex — Interspinous Process Decompression (1st level) | Covered |
22868 | Vertiflex — Interspinous (add'l level) | 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 |
64493 | Facet/MBB — Lumbar/Sacral (1st level) | Covered |
64633 | RFA — Cervical/Thoracic Facet (1st level) | Covered |
64635 | RFA — Lumbar/Sacral Facet (1st level) | Covered |
27096 | Sacroiliac Joint Injection | Covered |
64628 | Intracept — Basivertebral Nerve Ablation (1st) | Covered |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression | Not covered |
63650 | SCS — Percutaneous Trial | Covered |
63685 | SCS — Permanent Implant (IPG) | Covered |
22513 | Kyphoplasty — Thoracic (1st level) | Covered |
22514 | Kyphoplasty — Lumbar (1st level) | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Not covered |
62331 | MILD — Percutaneous Lumbar Decompression (with image guidance) | Not covered |
95885 | EMG, limited (with NCS) | Covered |
95886 | EMG, complete (with NCS) | Covered |
77003 | Fluoroscopic guidance, spine/joint | Covered |
76942 | Ultrasound guidance, needle placement | Covered |
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