CPT 64494 · Facet/MBB · CareFirst BCBS
Facet/MBB — Lumbar/Sacral (2nd level) at CareFirst BCBS.
How CareFirst BCBS approaches CPT 64494 (Facet/MBB — Lumbar/Sacral (2nd 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
CareFirst-eviCore-MSK-Pain (CMM-201)Criteria summary
High-level themes from the CareFirst BCBS policy of record for CPT 64494. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
Source: eviCore Musculoskeletal Interventional Pain — CareFirst BCBS PA List + CMM-201
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