CPT 64451 · SI Joint · Wellpoint Maryland
SI Joint Nerve Block (S1–S3 lateral branches) at Wellpoint Maryland.
How Wellpoint Maryland approaches CPT 64451 (SI Joint Nerve Block (S1–S3 lateral branches)) for prior-authorization review: at last review on 2026-04-27, the policy does not cover this code with prior authorization required.
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Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint Maryland 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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