CPT 64494 · Facet/MBB · Horizon NJ Health — NJ Medicaid
Facet/MBB — Lumbar/Sacral (2nd level) at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
157Criteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid 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: Horizon BCBSNJ Medical Policy 157 — Facet Joint Injections/Medial Branch Blocks
See the full Horizon NJ Health — NJ Medicaid criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →