CPT 64492 · Facet/MBB · AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices
Facet/MBB — Cervical/Thoracic (3rd+ level) at AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices.
How AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices approaches CPT 64492 (Facet/MBB — Cervical/Thoracic (3rd+ level)) for prior-authorization review: at last review on 2026-05-06, the policy does not cover this code with prior authorization required.
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eviCore CMM-201Criteria summary
High-level themes from the AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices policy of record for CPT 64492. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: eviCore CMM-201 / Novitas JL L34892 — Facet Joint Interventions (≥3rd level non-covered)
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