CPT 64484 · Epidural · BCBS Texas
TFESI — Lumbar/Sacral (add'l level) at BCBS Texas.
How BCBS Texas approaches CPT 64484 (TFESI — Lumbar/Sacral (add'l level)) for prior-authorization review: at last review on 2024-10-28, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-10-28
Policy number
MSK01-0725.1v2Criteria summary
High-level themes from the BCBS Texas policy of record for CPT 64484. 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 BCBS Texas criteria.
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