CPT 64493 · Facet/MBB · Highmark BCBS
Facet/MBB — Lumbar/Sacral (1st level) at Highmark BCBS.
How Highmark BCBS approaches CPT 64493 (Facet/MBB — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-26
Policy number
eviCore CMM-201 (Highmark)Criteria summary
High-level themes from the Highmark BCBS 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.
Source: Highmark Commercial Prior-Auth List — eviCore MSK delegation
See the full Highmark BCBS criteria.
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