CPT 64490 · Facet/MBB · Vermont Medicaid (Green Mountain Care)
Facet/MBB — Cervical/Thoracic (1st level) at Vermont Medicaid (Green Mountain Care).
How Vermont Medicaid (Green Mountain Care) 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 Vermont Medicaid (Green Mountain Care) 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: Vermont Department of Vermont Health Access (DVHA) Medicaid Provider Manual
See the full Vermont Medicaid (Green Mountain Care) criteria.
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