CPT 64484 · Epidural · Medicare (Noridian JE MAC)
TFESI — Lumbar/Sacral (add'l level) at Medicare (Noridian JE MAC).
How Medicare (Noridian JE MAC) approaches CPT 64484 (TFESI — Lumbar/Sacral (add'l level)) for prior-authorization review: at last review on 2026-04-16, the policy covers this code without prior authorization.
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L39240Criteria summary
High-level themes from the Medicare (Noridian JE MAC) 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: LCD L39240 — Epidural Steroid Injections for Pain Management (Noridian)
See the full Medicare (Noridian JE MAC) criteria.
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