Payor
Michigan Medicaid
Rubrica tracks 100 sourced coverage rules across 100 CPT codes for Michigan Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: mi).
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Every Rubrica record cites a specific Michigan Medicaid 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
Michigan Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Diagnostic | 22 | 22 | 22 | 0 |
| Epidural | 10 | 10 | 10 | 0 |
| Peripheral Nerve Block | 8 | 8 | 8 | 0 |
| Other Procedure | 7 | 7 | 7 | 0 |
| RFA | 7 | 7 | 7 | 0 |
| Peripheral Joint/Tendon | 5 | 5 | 5 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| Decompression | 4 | 4 | 4 | 0 |
| Regenerative | 4 | 4 | 4 | 0 |
| SCS | 4 | 4 | 4 | 0 |
| SI Fusion | 4 | 4 | 4 | 0 |
| Botulinum Toxin | 3 | 3 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the Michigan Medicaid catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
27447 | Total Knee Arthroplasty (TKA) | Covered |
27130 | Total Hip Arthroplasty (THA) | Covered |
23472 | Total Shoulder Arthroplasty (TSA / Reverse TSA) | Covered |
29827 | Arthroscopic Rotator Cuff Repair | Covered |
29888 | Arthroscopic ACL Reconstruction | Covered |
22551 | ACDF — Anterior Cervical Discectomy and Fusion | Covered |
22612 | PLF — Posterior Lumbar Fusion (Posterolateral) | Covered |
22558 | ALIF — Anterior Lumbar Interbody Fusion | Covered |
63030 | Laminotomy with Disc Excision — Lumbar | Covered |
63047 | Laminectomy with Facetectomy and Foraminotomy — Lumbar | Covered |
0200T | Percutaneous Diskectomy | Covered |
0201T | Percutaneous Diskectomy - Lumbar | Covered |
0232T | Interlaminar Endoscopic Decompression | Covered |
0275T | Vertebral Body Fracture Reduction | Covered |
0627T | Transversus Abdominis Plane Block | Covered |
0629T | Collagen Meniscus Implant | Covered |
0779T | Subcutaneous Implanted Drug Infusion Pump | Covered |
11980 | Subcutaneous Implant Removal | Covered |
20526 | Carpal Tunnel Injection | Covered |
20552 | Joint Injection - Shoulder | Covered |
20553 | Joint Injection - Knee | Covered |
20610 | Arthrocentesis - Major Joint | Covered |
20611 | Arthrocentesis - Intermediate Joint | Covered |
22510 | Posterior Vertebral Body Tethering | Covered |
22511 | Corpectomy - Cervical | Covered |
See every policy for Michigan Medicaid.
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