CPT 64491 · Facet/MBB · Medicare (FCSO MAC)
Facet/MBB — Cervical/Thoracic (2nd level) at Medicare (FCSO MAC).
How Medicare (FCSO MAC) approaches CPT 64491 (Facet/MBB — Cervical/Thoracic (2nd level)) for prior-authorization review: at last review on 2026-05-09, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-09
Policy number
L33930Criteria summary
High-level themes from the Medicare (FCSO MAC) policy of record for CPT 64491. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
Source: LCD L33930 — Facet Joint Interventions for Pain Management (FCSO)
See the full Medicare (FCSO MAC) criteria.
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