Policy library / 77003 Commercial payer policies listing 77003 6 policies from 6 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Aetna policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Viscosupplementation PayerPolicy · AETNA-CPB-0179 Jan 1, 2024 Covered
BCBS Illinois policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Facet Joint Injections PayerPolicy · BCBSIL-SUR702.015 Jan 1, 2026 Covered
BCBS Montana policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Facet Joint Injections PayerPolicy · BCBSMT-SUR702.015 Jan 1, 2026 Covered
BCBS New Mexico policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Facet Joint Injections PayerPolicy · BCBSNM-SUR702.015 Jan 1, 2026 Covered
BCBS Oklahoma policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Facet Joint Injections PayerPolicy · BCBSOK-SUR702.015 Jan 1, 2026 Covered
Health Alliance Plan policies listing 77003, with the code’s status in each Policy Effective Status of 77003 Health Alliance Plan MSK Code List PayerPolicy · EVICORE-HPLAN-HAP-AB9D421BCDBD Jan 1, 2026 Prior auth required