CPT 64495 · Facet/MBB · Sunshine Health (Centene) — Florida Medicaid

Facet/MBB — Lumbar/Sacral (3rd+ level) at Sunshine Health (Centene) — Florida Medicaid.

How Sunshine Health (Centene) — Florida Medicaid 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.

Free with practitioner sign-in — magic-link email auth, no credit card.

Coverage Not covered

Prior auth Prior auth required

Last reviewed 2026-05-06

Policy numberCP.MP.171 / 59G-4.222 / L33930

Criteria summary

High-level themes from the Sunshine Health (Centene) — Florida Medicaid policy of record for CPT 64495. Verbatim policy text and per-criterion analysis are available after sign-in.

Conservative care expectations vary; sign in for specifics.

Source: Centene CP.MP.171 (Facet Joint Interventions) — adopted by Sunshine Health FL Medicaid; FL 59G-4.222 frequency cap + FCSO JN LCD L33930 clinical detail

See the full Sunshine Health (Centene) — Florida Medicaid criteria.

Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.

Facet/MBB — Lumbar/Sacral (3rd+ level) at Sunshine Health (Centene) — Florida Medicaid.

Criteria summary

See the full Sunshine Health (Centene) — Florida Medicaid criteria.

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