CPT 64624 · RFA · Highmark Wholecare — PA HealthChoices
Genicular Nerve RFA at Highmark Wholecare — PA HealthChoices.
How Highmark Wholecare — PA HealthChoices 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
HealthHelp IPM — Genicular Nerve Radiofrequency AblationCriteria summary
High-level themes from the Highmark Wholecare — PA HealthChoices 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 blocks (CPT 64454) documentation required (typically with ≥50% relief).
See the full Highmark Wholecare — PA HealthChoices criteria.
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