CPT 64494 · Facet/MBB · Medicare (WPS MAC)
Facet/MBB — Lumbar/Sacral (2nd level) at Medicare (WPS MAC).
How Medicare (WPS MAC) approaches CPT 64494 (Facet/MBB — Lumbar/Sacral (2nd level)) for prior-authorization review: at last review on 2026-05-09, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-09
Policy number
L38841Criteria summary
High-level themes from the Medicare (WPS MAC) policy of record for CPT 64494. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
Source: LCD L38841 — Facet Joint Interventions for Pain Management (WPS_GHA)
See the full Medicare (WPS MAC) criteria.
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