CPT 64494 · Facet/MBB · CareFirst Community Health Plan
Facet/MBB — Lumbar/Sacral (2nd level) at CareFirst Community Health Plan.
How CareFirst Community Health Plan approaches CPT 64494 (Facet/MBB — Lumbar/Sacral (2nd level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the CareFirst Community Health Plan 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.
- Imaging concordance documentation required.
Source: Maryland Medicaid HealthChoice Program / CareFirst Medical Policy
See the full CareFirst Community Health Plan criteria.
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