CPT 64490 · Facet/MBB · Ambetter
Facet/MBB — Cervical/Thoracic (1st level) at Ambetter.
How Ambetter approaches CPT 64490 (Facet/MBB — Cervical/Thoracic (1st level)) for prior-authorization review: at last review on 2025-04-01, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-04-01
Policy number
CP.MP.171Criteria summary
High-level themes from the Ambetter policy of record for CPT 64490. 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: Centene/Ambetter Clinical Policy CP.MP.171: Facet Joint Interventions
See the full Ambetter 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 →