CPT 64483 · Epidural · UnitedHealthcare Community Plan of Pennsylvania
TFESI — Lumbar/Sacral (1st level) at UnitedHealthcare Community Plan of Pennsylvania.
How UnitedHealthcare Community Plan of Pennsylvania approaches CPT 64483 (TFESI — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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UHC CP-PA Medicaid: ESI for Spinal Pain (eff 2026-03-01)Criteria summary
High-level themes from the UnitedHealthcare Community Plan of Pennsylvania 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 UnitedHealthcare Community Plan of Pennsylvania criteria.
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