CPT 64490 · Facet/MBB · Medicare (WPS MAC)
Facet/MBB — Cervical/Thoracic (1st level) at Medicare (WPS MAC).
How Medicare (WPS MAC) approaches CPT 64490 (Facet/MBB — Cervical/Thoracic (1st level)) for prior-authorization review: at last review on 2026-05-03, the policy covers this code without prior authorization.
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L38841Criteria summary
High-level themes from the Medicare (WPS MAC) 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: WPS LCD L38841 — Facet Joint Interventions for Pain Management (companion article A58672)
See the full Medicare (WPS MAC) criteria.
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