Payor
New Jersey Medicaid
Rubrica tracks 90 sourced coverage rules across 90 CPT codes for New Jersey Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid. 1-state regional policy (sample: nj).
Free with practitioner sign-in — magic-link email auth, no credit card.
Every Rubrica record cites a specific New Jersey 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
New Jersey Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Diagnostic | 14 | 14 | 0 | 0 |
| Vertebral Augmentation | 10 | 8 | 8 | 2 |
| SCS | 7 | 7 | 7 | 0 |
| Intrathecal Pump | 6 | 6 | 6 | 0 |
| HCPCS Drug | 5 | 5 | 5 | 0 |
| Intradiscal | 5 | 3 | 3 | 2 |
| Botulinum Toxin | 4 | 4 | 4 | 0 |
| Epidural | 4 | 4 | 4 | 0 |
| PNS | 4 | 4 | 4 | 0 |
| SI Joint | 4 | 4 | 4 | 0 |
| Sympathetic | 4 | 4 | 4 | 0 |
| Decompression | 3 | 2 | 2 | 1 |
Top tracked procedures
First 15 CPT codes in the New Jersey Medicaid catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
0200T | Sacroplasty — Unilateral | Not covered |
0201T | Sacroplasty — Bilateral | Not covered |
0232T | PRP — Platelet Rich Plasma Injection | Not covered |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Not covered |
0627T | ViaDisc / Disc Allograft — Lumbar (1st level) | Not covered |
0629T | ViaDisc / Disc Allograft — Cervical/Thoracic (1st level) | Not covered |
0779T | Percutaneous Tenotomy / Ultrasonic Debridement | Not covered |
11980 | Testopel (testosterone pellet implantation) | Covered |
20526 | Carpal Tunnel Injection | Covered |
20552 | Trigger Point Injection — 1 or 2 muscles | Covered |
20553 | Trigger Point Injection — 3+ muscles | Covered |
20610 | Major Joint Injection (without US/Fluoro) | Covered |
20611 | Major Joint Injection (with US) | Covered |
22510 | Vertebroplasty — Cervicothoracic (1st level) | Covered |
22511 | Vertebroplasty — Lumbosacral (1st level) | Covered |
22513 | Kyphoplasty — Thoracic (1st level) | Covered |
22514 | Kyphoplasty — Lumbar (1st level) | Covered |
22520 | Vertebroplasty — Thoracic (legacy) | Covered |
22521 | Vertebroplasty — Lumbar (1st level) | Covered |
22523 | Kyphoplasty — Thoracic (legacy) | Covered |
22524 | Kyphoplasty — Lumbar (1st level, legacy code) | Covered |
22867 | Vertiflex — Interspinous Process Decompression (1st level) | Covered |
22869 | Vertiflex — Interspinous (1st level, no decompression) | Covered |
27096 | Sacroiliac Joint Injection (CPT) | Covered |
27279 | SI Fusion — Minimally Invasive | Covered |
See every policy for New Jersey Medicaid.
Sign in for verbatim coverage criteria, conservative-care requirements, source citations, and the denial-risk score for any clinical scenario.
Sign in — free for practitioners →