CPT 64484 · Epidural · PA Medical Assistance (FFS)
TFESI — Lumbar/Sacral (add'l level) at PA Medical Assistance (FFS).
How PA Medical Assistance (FFS) 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 without prior authorization.
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L36920Criteria summary
High-level themes from the PA Medical Assistance (FFS) 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: PA Medical Assistance Provider Handbook & Fee Schedule (FFS)
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