Payor
Medicare (Noridian JE MAC)
Rubrica tracks 80 sourced coverage rules across 80 CPT codes for Medicare (Noridian JE MAC) — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicare, medicare. 6-state regional policy (sample: as, ca, gu, hi, mp, nv).
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Every Rubrica record cites a specific Medicare (Noridian JE MAC) 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
Medicare (Noridian JE MAC)'s coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Other Procedure | 21 | 21 | 2 | 0 |
| Decompression | 8 | 6 | 0 | 1 |
| Vertebral Augmentation | 8 | 8 | 0 | 0 |
| Epidural | 6 | 6 | 2 | 0 |
| Facet/MBB | 6 | 4 | 0 | 0 |
| Intradiscal | 5 | 1 | 0 | 4 |
| Interspinous Device | 4 | 4 | 0 | 0 |
| Intrathecal Pump | 4 | 4 | 0 | 0 |
| PNS | 4 | 4 | 0 | 0 |
| RFA | 4 | 4 | 0 | 0 |
| SCS | 4 | 4 | 0 | 0 |
| SI Fusion | 2 | 2 | 1 | 0 |
Top tracked procedures
First 15 CPT codes in the Medicare (Noridian JE MAC) 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 |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Covered |
62331 | MILD — Percutaneous Lumbar Decompression (with image guidance) | 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 |
0200T | Sacroplasty — Unilateral | Covered |
0201T | Sacroplasty — Bilateral | 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 |
See every policy for Medicare (Noridian JE MAC).
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