CPT 64493 · Facet/MBB · Veterans Affairs
Facet/MBB — Lumbar/Sacral (1st level) at Veterans Affairs.
How Veterans Affairs approaches CPT 64493 (Facet/MBB — Lumbar/Sacral (1st level)) for prior-authorization review: at last review on 2022-02-01, the policy covers this code with prior authorization required.
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Verification 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 Veterans Affairs 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: VA/DoD Clinical Practice Guideline — Diagnosis and Treatment of Low Back Pain
See the full Veterans Affairs criteria.
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