CPT 64495 · Facet/MBB · Ohio Medicaid
Facet/MBB — Lumbar/Sacral (3rd+ level) at Ohio Medicaid.
How Ohio Medicaid approaches CPT 64495 (Facet/MBB — Lumbar/Sacral (3rd+ level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the Ohio Medicaid 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: Ohio Medicaid Interventional Pain Management Coverage Guidelines
See the full Ohio Medicaid criteria.
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