CPT 64484 · Epidural · Horizon NJ Health — NJ Medicaid
TFESI — Lumbar/Sacral (add'l level) at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid approaches CPT 64484 (TFESI — Lumbar/Sacral (add'l 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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156Criteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid policy of record for CPT 64484. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Horizon BCBSNJ Medical Policy 156 — Epidural Steroid Injections
See the full Horizon NJ Health — NJ Medicaid criteria.
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