Rubrica

CPT 64490 · Facet/MBB · Humana Healthy Horizons in Florida

Facet/MBB — Cervical/Thoracic (1st level) at Humana Healthy Horizons in Florida.

How Humana Healthy Horizons in Florida approaches CPT 64490 (Facet/MBB — Cervical/Thoracic (1st 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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Coverage Covered
Prior auth Prior auth required
Last reviewed 2026-05-06
Policy numberHUM-2137-000 / 59G-4.222 / L33930

Criteria summary

High-level themes from the Humana Healthy Horizons in Florida policy of record for CPT 64490. Verbatim policy text and per-criterion analysis are available after sign-in.

Source: Humana MCP HUM-2137-000 (Injections for Chronic Pain Conditions) + FL Medicaid State Plan floor (Rule 59G-4.222 F.A.C.) + FCSO JN LCD L33930

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