CPT 62326, in plain terms, covers Placement of an interlaminar epidural or subarachnoid catheter in the lower back or sacrum for continuous or bolus infusion, without imaging guidance. CPT 62326 is referenced in 10 tracked payer policy changes from Aetna, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 62326 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 62326 on AAPC
Aetna's spinal ultrasound policy (CPT 76800) is now restricted to newborns and infants for specific clinical indications only. Spinal ultrasound for adults—including evaluation of back pain, radiculopathy, scoliosis, epidural abscess, and anesthesia guidance—is classified as experimental/investigational and is NOT covered. Billing teams must immediately identify and deny or redirect adult spinal ultrasound claims to ensure compliance.
Excellus BlueCross BlueShield medical policy 7.01.115 on epidural steroid injections (ESIs) and selective nerve root blocks (SNRBs) has a current effective date of October 15, 2026. Initial ESIs are considered medically appropriate for presumed radiculopathy or radicular pain after at least four weeks of conservative treatment, participation in a comprehensive pain management program, and level-specific neurologic findings, with advanced imaging within the past 24 months required for cervical/thoracic interlaminar and transforaminal ESIs. Repeat ESIs require at least 14 days since the prior injection and documented pain relief of at least 50% for at least two weeks, and ESIs are limited to three sessions per episode of pain per region in six months and four sessions per region in a rolling 12 months. ESIs performed with ultrasound guidance or with injectates other than anesthetic, corticosteroid, and/or contrast agent are considered investigational.
This revised Medicare Advantage policy (effective 07/01/2026) establishes specific clinical criteria for implantable and external infusion pumps for pain and spasticity management. Key changes include: requiring a baseline Modified Ashworth Scale score of ≥3 for baclofen trials, mandating a 2-point MAS reduction for permanent implantation, and defining 'failure of conservative therapy' requirements with a 50% pain reduction threshold for opioid/non-opioid trials. The policy also clarifies replacement/revision criteria and addresses postoperative external pumps.
Humana Medicare Advantage has revised their policy for implantable infusion pumps used for pain or spasticity management, establishing specific medical necessity criteria including temporary trial requirements and success metrics. The policy provides detailed coverage determination guidelines for both antispasmodic drugs for severe spasticity and drugs for severe intractable pain treatment.
Aetna considers intrathecal, interlaminar, or transforaminal epidural corticosteroids medically necessary for post-herpetic neuralgia (PHN). Aetna considers acupuncture, low-level laser therapy, transcranial magnetic stimulation, intravenous ketamine, intravenous lidocaine, peripheral nerve stimulation, pulsed radiofrequency of the dorsal root ganglion, sympathectomy, transcutaneous electrical nerve stimulation (TENS), and other listed modalities experimental, investigational, or unproven for PHN. Epidural and transforaminal injection codes CPT 62320 through 62327, 64479, 64480, 64483 and 64484 are covered when the selection criteria are met.
Aetna considers continuous epidural analgesia medically necessary for intractable CRPS when the member has had pain for more than 3 months despite conservative therapy, has failed a trial of physical therapy, and has failed a trial of nerve blocks with local anesthetics and steroids. Sympathetic blocks (stellate ganglion and lumbar sympathetic blocks) are medically necessary for diagnosis and treatment when 3 months of conservative treatment, including analgesia and physical therapy, has failed, with up to 3 injections considered medically necessary and repeat blocks beyond the first 3 considered medically necessary only as part of a comprehensive pain management program. Dorsal column stimulators are medically necessary durable medical equipment for CRPS when the member meets all criteria in CPB 0194, Spinal Cord Stimulation, and Aetna considers many other listed approaches experimental, investigational or unproven for CRPS.
Blue Cross and Blue Shield of Mississippi requires general anesthesia to be reported with CPT anesthesia codes (00100-01999) and the HCPCS Level II anesthesia modifiers, and it will not accept CPT surgical or medicine codes (10020-69999 and 90000 series) with an anesthesia modifier appended. Anesthesia time is reported in minutes with one unit for each 15-minute increment, and the allowable charge is calculated from anesthesia base units, time units, physical status modifier, qualifying circumstances and specialized monitoring. The policy also sets separate rules for epidural catheter placement and daily management, neuraxial labor analgesia, moderate sedation, monitored anesthesia care, regional anesthesia, and CMS-1500 or UB-04 claim filing.
Epidural or intrathecal morphine administration for the management of severe, intractable pain is considered eligible for coverage. Intraventricular morphine administration is considered investigational. The policy was reviewed on 01/14/2026 with its policy statements unchanged, and its code reference section was updated to remove ICD-9 procedure codes.
Historical Blue Cross Blue Shield of Rhode Island provider update items dated 2016 and 2017 include coverage and billing changes that have passed. Prescription drug claims moved to Prime Therapeutics from January 1, 2017, and primary care providers were required to submit specialist referrals through the web-based referral management tool for dates of service on or after that date. Other dated changes include prior authorization for artificial cervical disc insertion from February 1, 2017, no prior authorization for CPT 81507 and covered status for CPT 81420 for non-invasive prenatal testing from January 1, 2017, and BlueCHiP for Medicare coverage of prostatic urethral lifts from January 1, 2017. Because these dates have passed, confirm current applicability before acting.
Already effective September 1, 2017, BCBSRI requires providers to report the name and Type 1 NPI of the ordering provider on the CMS-1500 claim or electronic submission for laboratory, imaging, durable medical equipment and home infusion services, and missing or incomplete information results in the claim being rejected back to the provider. Already effective January 1, 2017, CPT 62320, 62322, 62324 and 62326 changed from not medically necessary to medically necessary with prior authorization, and CPT 83861 is covered and separately reimbursed for commercial and BlueCHiP for Medicare products. Already effective September 1, 2017, CPT 92227 and 92228 are covered for BlueCHiP for Medicare only when filed by an optometrist or ophthalmologist, and CPT 92228 is not medically necessary for commercial products for other indications.
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