Payor
Railroad Medicare (Palmetto GBA national)
Rubrica tracks 306 sourced coverage rules across 306 CPT codes for Railroad Medicare (Palmetto GBA national) — covering interventional spine, pain management, ortho spine, and orthopedics. National policy.
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Every Rubrica record cites a specific Railroad Medicare (Palmetto GBA national) 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
Railroad Medicare (Palmetto GBA national)'s coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Decompression — Surgical | 30 | 30 | 0 | 0 |
| Arthroscopy — Knee | 15 | 15 | 0 | 0 |
| Diagnostic | 14 | 14 | 0 | 0 |
| Vertebral Augmentation | 14 | 14 | 0 | 0 |
| Arthroscopy — Shoulder | 13 | 13 | 0 | 0 |
| Foot / Ankle | 13 | 13 | 0 | 0 |
| Hand / Upper Extremity | 10 | 10 | 0 | 0 |
| Spinal Instrumentation | 9 | 9 | 0 | 0 |
| Trauma — Lower Extremity | 9 | 9 | 0 | 0 |
| HCPCS Drug — Viscosupplementation | 8 | 8 | 0 | 0 |
| Intradiscal | 8 | 8 | 0 | 0 |
| Trauma — Upper Extremity | 8 | 8 | 0 | 0 |
Top tracked procedures
First 15 CPT codes in the Railroad Medicare (Palmetto GBA national) catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
62321 | Interlaminar ESI — Cervical/Thoracic | Covered |
62323 | Interlaminar ESI — Lumbar | Covered |
64479 | TFESI — Cervical/Thoracic (1st level) | Covered |
64480 | TFESI — Cervical/Thoracic (add'l level) | Covered |
64483 | TFESI — Lumbar/Sacral (1st level) | Covered |
64484 | TFESI — Lumbar/Sacral (add'l level) | Covered |
64490 | Facet/MBB — Cervical/Thoracic (1st level) | Covered |
64491 | Facet/MBB — Cervical/Thoracic (2nd level) | Covered |
64492 | Facet/MBB — Cervical/Thoracic (3rd+ level) | Covered |
64493 | Facet/MBB — Lumbar/Sacral (1st level) | Covered |
64494 | Facet/MBB — Lumbar/Sacral (2nd level) | Covered |
64495 | Facet/MBB — Lumbar/Sacral (3rd+ level) | Covered |
64633 | RFA — Cervical/Thoracic Facet (1st level) | Covered |
64634 | RFA — Cervical/Thoracic Facet (add'l level) | Covered |
64635 | RFA — Lumbar/Sacral Facet (1st level) | Covered |
64636 | RFA — Lumbar/Sacral Facet (add'l level) | Covered |
27096 | Sacroiliac Joint Injection (CPT) | Covered |
G0260 | SI Joint Injection (Medicare ASC HCPCS) | Covered |
64451 | SI Joint Nerve Block (S1–S3 lateral branches) | Covered |
64625 | SI Joint RFA (lateral branches) | Covered |
27279 | SI Fusion — Minimally Invasive | Covered |
27280 | SI Fusion — Open | Covered |
63650 | SCS — Percutaneous Trial | Covered |
63661 | SCS — Lead Revision/Removal (percutaneous) | Covered |
63685 | SCS — Permanent Implant (IPG) | Covered |
See every policy for Railroad Medicare (Palmetto GBA national).
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