Rubrica

CPT 64451 · SI Joint · Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid

SI Joint Nerve Block (S1–S3 lateral branches) at Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid.

How Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid approaches CPT 64451 (SI Joint Nerve Block (S1–S3 lateral branches)) for prior-authorization review: at last review on 2026-05-06, the policy does not cover this code with prior authorization required.

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Coverage Not covered
Prior auth Prior auth required
InvestigationalInvestigational / experimental
Last reviewed 2026-05-06
Policy numberCarelon IPM MSK01 (2026-06-14)

Criteria summary

High-level themes from the Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid 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: Carelon Clinical Appropriateness Guidelines — Interventional Pain Management (SI joint section)

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