CPT 64495 · Facet/MBB · Geisinger Health Plan — PA HealthChoices
Facet/MBB — Lumbar/Sacral (3rd+ level) at Geisinger Health Plan — PA HealthChoices.
How Geisinger Health Plan — PA HealthChoices approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2026-05-06, the policy does not cover this code with prior authorization required.
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Cohere Pain / Novitas L34892Criteria summary
High-level themes from the Geisinger Health Plan — PA HealthChoices policy of record for CPT 64495. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Geisinger Health Plan PA List — Interventional Pain Management (Cohere-delegated)
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