CPT 64483 · Epidural · Ambetter
TFESI — Lumbar/Sacral (1st level) at Ambetter.
How Ambetter approaches CPT 64483 (TFESI — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2024-07-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-07-01
Policy number
CP.MP.165Criteria summary
High-level themes from the Ambetter policy of record for CPT 64483. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Ambetter criteria.
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