CPT 64495 · Facet/MBB · BCBS Texas
Facet/MBB — Lumbar/Sacral (3rd+ level) at BCBS Texas.
How BCBS Texas approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2024-10-28, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-10-28
Policy number
MSK01-0725.1v2Criteria summary
High-level themes from the BCBS Texas policy of record for CPT 64495. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full BCBS Texas criteria.
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