CPT 64480 · Epidural · Ambetter
TFESI — Cervical/Thoracic (add'l level) at Ambetter.
How Ambetter approaches CPT 64480 (TFESI — Cervical/Thoracic (add'l level)) for prior-authorization review: at last review on 2024-08-01, the policy covers this code with prior authorization required.
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CP.MP.165Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Ambetter policy of record for CPT 64480. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Ambetter Centene CP.MP.165
See the full Ambetter criteria.
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