CPT 64490 · Facet/MBB · Kaiser Permanente Hawaii
Facet/MBB — Cervical/Thoracic (1st level) at Kaiser Permanente Hawaii.
How Kaiser Permanente Hawaii approaches CPT 64490 (Facet/MBB — Cervical/Thoracic (1st level)) for prior-authorization review: at last review on 2026-05-03, the policy does not cover this code without prior authorization.
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Criteria summary
High-level themes from the Kaiser Permanente Hawaii policy of record for CPT 64490. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Kaiser Permanente Hawaii Region Clinical Coverage Policy
See the full Kaiser Permanente Hawaii criteria.
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