CPT 64492 · Facet/MBB · Premera Blue Cross
Facet/MBB — Cervical/Thoracic (3rd+ level) at Premera Blue Cross.
How Premera Blue Cross approaches CPT 64492 (Facet/MBB — Cervical/Thoracic (3rd+ level)) for prior-authorization review: at last review on 2025-07-07, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-07-07
Policy number
7.01.575Criteria summary
High-level themes from the Premera Blue Cross policy of record for CPT 64492. 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: Premera Medical Policy 7.01.575
See the full Premera Blue Cross criteria.
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