CPT 64484 · Epidural · Excellus BCBS
TFESI — Lumbar/Sacral (add'l level) at Excellus BCBS.
How Excellus BCBS approaches CPT 64484 (TFESI — Lumbar/Sacral (add'l level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-27
Policy number
7.01.115Criteria summary
High-level themes from the Excellus BCBS 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.
Source: Excellus BCBS Medical Policy 7.01.115 — Epidural Steroid Injections
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