CPT 64624 · RFA · Fidelis Care NJ (Centene) — NJ Medicaid
Genicular Nerve RFA at Fidelis Care NJ (Centene) — NJ Medicaid.
How Fidelis Care NJ (Centene) — NJ Medicaid approaches CPT 64624 (Genicular Nerve RFA) 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 number
Evolent IPM 2025 + Fidelis NJ Medicaid Provider ManualCriteria summary
High-level themes from the Fidelis Care NJ (Centene) — NJ Medicaid policy of record for CPT 64624. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic genicular nerve block(s) under image guidance documentation required (typically with ≥80% relief).
See the full Fidelis Care NJ (Centene) — NJ Medicaid criteria.
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