CPT 64484 · Epidural · BCBS Alabama
TFESI — Lumbar/Sacral (add'l level) at BCBS Alabama.
How BCBS Alabama approaches CPT 64484 (TFESI — Lumbar/Sacral (add'l level)) for prior-authorization review: at last review on 2024-12-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-12-01
Policy number
BCBS-AL MP-303Criteria summary
High-level themes from the BCBS Alabama policy of record for CPT 64484. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 2 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: BCBS Alabama Medical Policy MP-303 Epidural Steroid Injections for Back Pain
See the full BCBS Alabama criteria.
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