CPT 64624 · RFA · Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid
Genicular Nerve RFA at Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid.
How Simply Healthcare Plans (Anthem/Elevance) — Florida 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
Criteria summary
High-level themes from the Simply Healthcare Plans (Anthem/Elevance) — Florida 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) with ≥80% relief of index pain documentation required (typically with ≥80% relief).
Source: Simply FL UM — genicular RFA (Carelon-aligned framework; no dedicated Carelon guideline)
See the full Simply Healthcare Plans (Anthem/Elevance) — 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.
Sign in — free for practitioners →