Rubrica

Payor

Independence BCBS PA

Rubrica tracks 29 sourced coverage rules across 29 CPT codes for Independence BCBS PA — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): commercial. 3-state regional policy (sample: de, nj, pa).

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29
Sourced rules
29
CPT codes tracked
27
Covered (93%)
27
Prior auth required

Every Rubrica record cites a specific Independence BCBS PA 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

Independence BCBS PA's coverage stance across procedure categories tracked in the Rubrica catalog.

CategoryRulesCoveredPrior authInvestigational
Other Procedure1515140
Spine Surgery5550
Decompression3132
Arthroplasty — Hip1110
Arthroplasty — Knee1110
Arthroplasty — Shoulder1110
Arthroscopy — Knee1110
Arthroscopy — Shoulder1110
Diagnostic1100

Top tracked procedures

First 15 CPT codes in the Independence BCBS PA catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.

CPTProcedureCoverage
27447Total Knee Arthroplasty (TKA)Covered
27130Total Hip Arthroplasty (THA)Covered
23472Total Shoulder Arthroplasty (TSA / Reverse TSA)Covered
29827Arthroscopic Rotator Cuff RepairCovered
29888Arthroscopic ACL ReconstructionCovered
22551ACDF — Anterior Cervical Discectomy and FusionCovered
22612PLF — Posterior Lumbar Fusion (Posterolateral)Covered
22558ALIF — Anterior Lumbar Interbody FusionCovered
63030Laminotomy (Hemilaminectomy) with Disc Excision — LumbarCovered
63047Laminectomy with Facetectomy and Foraminotomy — LumbarCovered
62287Percutaneous Lumbar Decompression of Nucleus Pulposus (Decompressor / Coblation)Not covered
62380Endoscopic Decompression of Spinal Cord/Nerve Root — Lumbar (single interspace)Not covered
27446Unicompartmental Knee Arthroplasty (UKA)Covered
27487Revision Total Knee Arthroplasty — Femoral and Entire Tibial ComponentCovered
27486Revision Total Knee Arthroplasty — One ComponentCovered
27134Revision Total Hip Arthroplasty — Both ComponentsCovered
29882Knee Arthroscopy with Meniscus RepairCovered
29848Endoscopic Carpal Tunnel ReleaseCovered
23430Tenodesis of Long Tendon of BicepsCovered
24363Total Elbow ArthroplastyCovered
29805Diagnostic Shoulder ArthroscopyCovered
29881Knee Arthroscopy with Meniscectomy (Medial OR Lateral)Covered
29880Knee Arthroscopy with Meniscectomy (Medial AND Lateral)Covered
22630PLIF — Posterior Lumbar Interbody FusionCovered
22633Combined Posterior + Posterolateral Interbody Fusion (lumbar)Covered

See every policy for Independence BCBS PA.

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