CPT 64483 · Epidural · UPMC for You — PA HealthChoices
TFESI — Lumbar/Sacral (1st level) at UPMC for You — PA HealthChoices.
How UPMC for You — PA HealthChoices 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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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
L36920Criteria summary
High-level themes from the UPMC for You — PA HealthChoices 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 UPMC for You — PA HealthChoices criteria.
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