Facet/MBB — Lumbar/Sacral (1st level) at Aetna.
How Aetna approaches CPT 64493 (Facet/MBB — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2025-10-12, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-10-12
Policy number
CPB 0016Criteria summary
High-level themes from the Aetna policy of record for CPT 64493. 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.
See the full Aetna criteria.
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