CPT 64491 · Facet/MBB · Maryland Physicians Care
Facet/MBB — Cervical/Thoracic (2nd level) at Maryland Physicians Care.
How Maryland Physicians Care 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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NIA IPM Guidelines (2024)Criteria summary
High-level themes from the Maryland Physicians Care policy of record for CPT 64491. 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: MPC / Evolent (NIA) IPM Guidelines — Facet Joint / Medial Branch Block
See the full Maryland Physicians Care criteria.
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