Rubrica

CPT 64520 · Sympathetic · Wellpoint Maryland

Lumbar / Thoracic Sympathetic Block (also Ganglion Impar per practice) at Wellpoint Maryland.

How Wellpoint Maryland approaches CPT 64520 (Lumbar / Thoracic Sympathetic Block (also Ganglion Impar per practice)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code without prior authorization.

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Coverage Covered
Prior auth No prior auth
Last reviewed 2026-04-27

Criteria summary

High-level themes from the Wellpoint Maryland policy of record for CPT 64520. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: MD Medicaid FFS / Novitas JL — case-by-case medical-necessity standard (no LCD specific to sympathetic blocks)

See the full Wellpoint Maryland criteria.

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