CPT 64491 · Facet/MBB · BCBS Massachusetts
Facet/MBB — Cervical/Thoracic (2nd level) at BCBS Massachusetts.
How BCBS Massachusetts approaches CPT 64491 (Facet/MBB — Cervical/Thoracic (2nd level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-27
Policy number
MP 140Criteria summary
High-level themes from the BCBS Massachusetts policy of record for CPT 64491. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full BCBS Massachusetts criteria.
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