Rubrica

CPT 64451 · SI Joint · PA Medical Assistance (FFS)

SI Joint Nerve Block (S1–S3 lateral branches) at PA Medical Assistance (FFS).

How PA Medical Assistance (FFS) approaches CPT 64451 (SI Joint Nerve Block (S1–S3 lateral branches)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.

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Coverage Covered
Prior auth No prior auth
Last reviewed 2026-05-06

Criteria summary

High-level themes from the PA Medical Assistance (FFS) policy of record for CPT 64451. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: PA Medical Assistance Provider Handbook & Fee Schedule (FFS)

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