CPT 64493 · Facet/MBB · UnitedHealthcare (Commercial)
Facet/MBB — Lumbar/Sacral (1st level) at UnitedHealthcare (Commercial).
How UnitedHealthcare (Commercial) approaches CPT 64493 (Facet/MBB — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2026-04-24, the policy covers this code with prior authorization required.
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2026T0004UUCriteria summary
High-level themes from the UnitedHealthcare (Commercial) 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.
Source: UHC Commercial/Individual Exchange — Facet Joint and Medial Branch Block Injections for Spinal Pain
See the full UnitedHealthcare (Commercial) criteria.
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