Rubrica

CPT 64530 · Sympathetic · Health Partners Plans / Jefferson Health Plans — PA HealthChoices

Celiac Plexus Block at Health Partners Plans / Jefferson Health Plans — PA HealthChoices.

How Health Partners Plans / Jefferson Health Plans — PA HealthChoices approaches CPT 64530 (Celiac Plexus Block) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.

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Coverage Covered
Prior auth Prior auth required
Last reviewed 2026-05-06
Policy numbereviCore Sympathetic Blocks

Criteria summary

High-level themes from the Health Partners Plans / Jefferson Health Plans — PA HealthChoices policy of record for CPT 64530. Verbatim policy text and per-criterion analysis are available after sign-in.

Source: eviCore by Evernorth — Sympathetic Block Clinical Guidelines (HPP/Jefferson MSK Pain Management Program)

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