CPT 64494 · Facet/MBB · MedStar Family Choice — Maryland Medicaid
Facet/MBB — Lumbar/Sacral (2nd level) at MedStar Family Choice — Maryland Medicaid.
How MedStar Family Choice — Maryland 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 without prior authorization.
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L34892Criteria summary
High-level themes from the MedStar Family Choice — Maryland Medicaid policy of record for CPT 64494. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
Source: Maryland Medicaid Professional Services Provider Manual & Fee Schedule (FFS)
See the full MedStar Family Choice — Maryland Medicaid criteria.
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