CPT 64483 · ESI · Independence Blue Cross
TFESI — Lumbar/Sacral (1st level) at Independence Blue Cross.
How Independence Blue Cross approaches CPT 64483 (TFESI — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2025-06-11, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-06-11
Policy number
11.15.23lCriteria summary
High-level themes from the Independence Blue Cross policy of record for CPT 64483. 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.
See the full Independence Blue Cross criteria.
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