CPT 64495 · Facet/MBB · BCBS Alabama
Facet/MBB — Lumbar/Sacral (3rd+ level) at BCBS Alabama.
How BCBS Alabama approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2025-01-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-01-01
Policy number
BCBS-AL-Facet-deferCriteria summary
High-level themes from the BCBS Alabama policy of record for CPT 64495. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: BCBS Alabama Medical Policy (facet joint injections — specific MP not located)
See the full BCBS Alabama criteria.
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