Payor
UnitedHealthcare Medicare Advantage
Rubrica tracks 306 sourced coverage rules across 306 CPT codes for UnitedHealthcare Medicare Advantage — covering interventional spine, pain management, ortho spine, and orthopedics. Plan type(s): Medicare Advantage, medicare_advantage. National policy.
Free with practitioner sign-in — magic-link email auth, no credit card.
Every Rubrica record cites a specific UnitedHealthcare Medicare Advantage 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
UnitedHealthcare Medicare Advantage's coverage stance across procedure categories tracked in the Rubrica catalog.
| Category | Rules | Covered | Prior auth | Investigational |
|---|---|---|---|---|
| Decompression — Surgical | 28 | 28 | 28 | 0 |
| Arthroscopy — Knee | 15 | 15 | 15 | 0 |
| Diagnostic | 14 | 14 | 10 | 0 |
| Vertebral Augmentation | 14 | 12 | 14 | 0 |
| Arthroscopy — Shoulder | 13 | 13 | 13 | 0 |
| Foot / Ankle | 13 | 13 | 13 | 0 |
| Hand / Upper Extremity | 10 | 10 | 10 | 0 |
| Spinal Instrumentation | 9 | 9 | 9 | 0 |
| Trauma — Lower Extremity | 9 | 9 | 9 | 0 |
| HCPCS Drug — Viscosupplementation | 8 | 8 | 8 | 0 |
| Intradiscal | 8 | 0 | 8 | 0 |
| Trauma — Upper Extremity | 8 | 8 | 8 | 0 |
Top tracked procedures
First 15 CPT codes in the UnitedHealthcare Medicare Advantage catalog. Sign in for verbatim criteria, source links, and the rest of the catalog.
| CPT | Procedure | Coverage |
|---|---|---|
63650 | SCS — Percutaneous Trial | Covered |
63685 | SCS — Permanent Implant (IPG) | Covered |
63661 | SCS — Lead Revision/Removal (percutaneous) | Covered |
63688 | SCS — Generator Revision/Removal | Covered |
0275T | MILD — Percutaneous Image-Guided Lumbar Decompression (DELETED 2026) | Covered |
62330 | MILD — Percutaneous Lumbar Decompression (no image guidance) | Covered |
62331 | MILD — Percutaneous Lumbar Decompression (with image guidance) | Covered |
64555 | PNS — Percutaneous Lead Trial/Placement | Covered |
64580 | PNS — Open Electrode Placement (neuromuscular) | Covered |
64590 | PNS — Generator Insertion | Covered |
64595 | PNS — Generator Revision/Removal | Covered |
22867 | Vertiflex — Interspinous Process Decompression (1st level) | Not covered |
22868 | Vertiflex — Interspinous (add'l level) | Not covered |
0627T | ViaDisc / Disc Allograft — Lumbar (1st) | Not covered |
0628T | ViaDisc — Lumbar (additional level) | Not covered |
0629T | ViaDisc — Cervical/Thoracic (1st) | Not covered |
0630T | ViaDisc — Cervical/Thoracic (add'l) | Not covered |
64628 | Intracept — Basivertebral Nerve Ablation (1st) | Not covered |
64629 | Intracept — BVN Ablation (add'l) | Not covered |
62380 | Endoscopic Lumbar Decompression | Not covered |
0200T | Sacroplasty — Unilateral | Not covered |
0201T | Sacroplasty — Bilateral | Not covered |
22513 | Kyphoplasty — Thoracic (1st level) | Covered |
22514 | Kyphoplasty — Lumbar (1st level) | Covered |
22515 | Kyphoplasty — Each Additional Level | Covered |
See every policy for UnitedHealthcare Medicare Advantage.
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 →