Rubrica

CPT 64490 · Facet/MBB · Sunshine Health (Centene) — Florida Medicaid

Facet/MBB — Cervical/Thoracic (1st level) at Sunshine Health (Centene) — Florida Medicaid.

How Sunshine Health (Centene) — Florida Medicaid 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 numberCP.MP.171 / 59G-4.222 / L33930

Criteria summary

High-level themes from the Sunshine Health (Centene) — Florida Medicaid policy of record for CPT 64490. Verbatim policy text and per-criterion analysis are available after sign-in.

Source: Centene CP.MP.171 (Facet Joint Interventions) — adopted by Sunshine Health FL Medicaid; FL 59G-4.222 frequency cap + FCSO JN LCD L33930 clinical detail

See the full Sunshine Health (Centene) — Florida Medicaid criteria.

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