CPT 64484 · Epidural · Wellpoint Maryland
TFESI — Lumbar/Sacral (add'l level) at Wellpoint Maryland.
How Wellpoint Maryland 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint Maryland 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: Carelon Clinical Appropriateness Guidelines — Interventional Pain Management
See the full Wellpoint Maryland criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →