Payor
New York Medicaid
Rubrica tracks 101 sourced coverage rules across 101 CPT codes for New York Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: ny).
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Every Rubrica record cites a specific New York 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 York Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Chemodenervation | 9 | 9 | 9 | 0 |
| Diagnostic | 8 | 8 | 0 | 0 |
| Spinal Fusion | 8 | 8 | 8 | 0 |
| Epidural Injection | 6 | 6 | 6 | 0 |
| Transforaminal Epidural Injection | 6 | 6 | 6 | 0 |
| Joint Injection | 5 | 5 | 4 | 0 |
| Neuromodulation | 5 | 5 | 3 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| Facet Joint Injection | 4 | 4 | 4 | 0 |
| Intra-articular Injection | 4 | 4 | 4 | 0 |
| Device Management | 3 | 3 | 1 | 0 |
| Imaging | 3 | 3 | 0 | 0 |
Top tracked procedures
First 15 CPT codes in the New York 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 sacroiliac joint arthrocentesis | Covered |
0201T | Percutaneous sacroiliac joint injection | Covered |
0232T | Injection(s), platelet rich plasma, any site | Not covered |
0275T | Injection(s), bone marrow aspirate concentrate, any site | Not covered |
0627T | Ablation, nerves, percutaneous, lower extremity | Covered |
0629T | Ablation, nerves, percutaneous, upper extremity | Covered |
0779T | Arthroscopy, metacarpophalangeal and interphalangeal joint, diagnostic | Covered |
11980 | Subcutaneous implantable neurostimulator electrode array, including insertion | Covered |
20526 | Injection, therapeutic (nonradioactive), intra-articular; any joint | Covered |
20552 | Injection(s), single or multiple trigger point(s), 1 or 2 muscle(s) | Covered |
20553 | Injection(s), single or multiple trigger point(s), 3 or more muscles | Covered |
20610 | Arthrocentesis, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | Covered |
20611 | Arthrocentesis, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance | Covered |
22510 | Percutaneous posterolateral interbody fusion (PLIF) or transforminal lumbar interbody fusion (TLIF); single level | Covered |
22511 | Percutaneous posterolateral interbody fusion (PLIF) or transforminal lumbar interbody fusion (TLIF); each additional level | Covered |
See every policy for New York Medicaid.
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