CPT 64495 · Facet/MBB · Medicare (CGS MAC)
Facet/MBB — Lumbar/Sacral (3rd+ level) at Medicare (CGS MAC).
How Medicare (CGS MAC) approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2026-05-09, the policy does not cover this code without prior authorization.
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Coverage
Not covered
Prior auth
No prior auth
Last reviewed
2026-05-09
Policy number
L38773Criteria summary
High-level themes from the Medicare (CGS MAC) 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: LCD L38773 (CGS)
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