CPT 64491 · Facet/MBB · Horizon NJ Health — NJ Medicaid
Facet/MBB — Cervical/Thoracic (2nd level) at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid approaches CPT 64491 (Facet/MBB — Cervical/Thoracic (2nd 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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157Criteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid policy of record for CPT 64491. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Horizon BCBSNJ Medical Policy 157 — Facet Joint Injections/Medial Branch Blocks
See the full Horizon NJ Health — NJ Medicaid criteria.
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