CPT 64495 · Facet/MBB · BCBS Federal Employee Program
Facet/MBB — Lumbar/Sacral (3rd+ level) at BCBS Federal Employee Program.
How BCBS Federal Employee Program approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-27
Policy number
FEP 7.01.116Criteria summary
High-level themes from the BCBS Federal Employee Program 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.
See the full BCBS Federal Employee Program criteria.
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