CPT 64490 · Facet/MBB · Maryland Physicians Care
Facet/MBB — Cervical/Thoracic (1st level) at Maryland Physicians Care.
How Maryland Physicians Care 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
NIA IPM Guidelines (2024)Criteria summary
High-level themes from the Maryland Physicians Care 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: MPC / Evolent (NIA) IPM Guidelines — Facet Joint / Medial Branch Block
See the full Maryland Physicians Care 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 →