Payor
Medicare (Palmetto GBA MAC)
Rubrica tracks 294 sourced coverage rules across 294 CPT codes for Medicare (Palmetto GBA MAC) — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicare, medicare. 7-state regional policy (sample: al, ga, nc, sc, tn, va).
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Every Rubrica record cites a specific Medicare (Palmetto GBA 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 (Palmetto GBA MAC)'s coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Procedure (templated) | 47 | 47 | 47 | 0 |
| Arthroscopy | 46 | 46 | 46 | 0 |
| Spinal Decompression | 27 | 27 | 25 | 0 |
| Other Procedure | 22 | 22 | 2 | 0 |
| Spinal Fusion | 19 | 19 | 14 | 0 |
| Trauma / Fracture | 16 | 16 | 0 | 0 |
| Joint Arthroplasty | 10 | 10 | 10 | 0 |
| Diagnostic — EMG/NCS | 8 | 8 | 0 | 0 |
| Vertebral Augmentation | 8 | 8 | 0 | 0 |
| Decompression | 7 | 7 | 4 | 0 |
| Epidural | 6 | 6 | 0 | 0 |
| Facet/MBB | 6 | 4 | 2 | 0 |
Top tracked procedures
First 15 CPT codes in the Medicare (Palmetto GBA 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 |
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 |
62321 | Cervical/thoracic interlaminar epidural injection with imaging guidance | Covered |
62323 | Lumbar/sacral interlaminar or caudal epidural injection with imaging guidance | Covered |
64479 | Cervical/thoracic transforaminal epidural injection (single level) | Covered |
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