Payor
Humana Medicare Advantage
Rubrica tracks 306 sourced coverage rules across 306 CPT codes for Humana Medicare Advantage — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicare Advantage, medicare_advantage. National policy.
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Every Rubrica record cites a specific Humana Medicare Advantage 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 Medicare Advantage's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Decompression — Surgical | 28 | 28 | 28 | 0 |
| Arthroscopy — Knee | 15 | 15 | 15 | 0 |
| Diagnostic | 14 | 14 | 10 | 0 |
| Vertebral Augmentation | 14 | 12 | 14 | 0 |
| Arthroscopy — Shoulder | 13 | 13 | 13 | 0 |
| Foot / Ankle | 13 | 13 | 13 | 0 |
| Hand / Upper Extremity | 10 | 10 | 10 | 0 |
| Spinal Instrumentation | 9 | 9 | 9 | 0 |
| Trauma — Lower Extremity | 9 | 9 | 9 | 0 |
| HCPCS Drug — Viscosupplementation | 8 | 8 | 8 | 0 |
| Trauma — Upper Extremity | 8 | 8 | 8 | 0 |
| Intradiscal | 7 | 1 | 7 | 0 |
Top tracked procedures
First 15 CPT codes in the Humana Medicare Advantage 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 |
64555 | PNS — Percutaneous Lead Trial/Placement | Covered |
64580 | PNS — Open Electrode Placement (neuromuscular) | Covered |
64590 | PNS — Generator Insertion | Covered |
64595 | PNS — Generator Revision/Removal | Covered |
22867 | Vertiflex — Interspinous Process Decompression (1st level) | Covered |
22868 | Vertiflex — Interspinous (add'l level) | Covered |
0627T | ViaDisc / Disc Allograft — Lumbar (1st) | Not covered |
0628T | ViaDisc — Lumbar (additional level) | Not covered |
0629T | ViaDisc — Cervical/Thoracic (1st) | Not covered |
0630T | ViaDisc — Cervical/Thoracic (add'l) | Not covered |
64629 | Intracept — BVN Ablation (add'l) | Covered |
62380 | Endoscopic Lumbar Decompression | Not covered |
0200T | Sacroplasty — Unilateral | Not covered |
0201T | Sacroplasty — Bilateral | Not covered |
22515 | Kyphoplasty — Each Additional Level | Covered |
27279 | SI Fusion — Minimally Invasive | 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 |
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