Payor
Ohio Medicaid
Rubrica tracks 116 sourced coverage rules across 109 CPT codes for Ohio Medicaid — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicaid, medicaid. 1-state regional policy (sample: oh).
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Every Rubrica record cites a specific Ohio 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
Ohio Medicaid's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Diagnostic | 14 | 14 | 0 | 0 |
| HCPCS Drug | 10 | 10 | 6 | 0 |
| Vertebral Augmentation | 10 | 10 | 10 | 0 |
| SCS | 9 | 9 | 6 | 0 |
| Intradiscal | 8 | 8 | 8 | 0 |
| Facet/MBB | 6 | 6 | 6 | 0 |
| Intrathecal Pump | 6 | 6 | 5 | 0 |
| RFA | 5 | 5 | 5 | 0 |
| Spine Surgery | 5 | 5 | 5 | 0 |
| Botulinum Toxin | 4 | 4 | 4 | 0 |
| Epidural | 4 | 4 | 4 | 0 |
| PNS | 4 | 4 | 3 | 0 |
Top tracked procedures
First 15 CPT codes in the Ohio 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 |
62321 | Interlaminar ESI — Cervical/Thoracic | Covered |
62323 | Interlaminar ESI — Lumbar | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Covered |
62331 | MILD — Percutaneous Lumbar Decompression (with image guidance) | Covered |
62350 | Pain Pump — Catheter Implantation (tunneled) | Covered |
62351 | Pain Pump — Catheter Implantation (with laminectomy) | Covered |
62362 | Pain Pump — Programmable Pump Insertion | Covered |
62365 | Pain Pump — Removal | Covered |
64479 | TFESI — Cervical/Thoracic (1st level) | Covered |
64483 | TFESI — Lumbar/Sacral (1st level) | Covered |
64490 | Facet/MBB — Cervical/Thoracic (1st level) | Covered |
64493 | Facet/MBB — Lumbar/Sacral (1st level) | Covered |
64491 | Facet/MBB — Cervical/Thoracic (2nd level) | Covered |
64492 | Facet/MBB — Cervical/Thoracic (3rd+ level) | Covered |
64494 | Facet/MBB — Lumbar/Sacral (2nd level) | Covered |
See every policy for Ohio Medicaid.
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