CPT 64493 · Facet/MBB · Horizon BCBS NJ
Facet/MBB — Lumbar/Sacral (1st level) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 64493 (Facet/MBB — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2026-05-11, the policy covers this code with prior authorization required.
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157Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ policy of record for CPT 64493. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Horizon BCBS NJ criteria.
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