CPT 64624 · RFA · UnitedHealthcare Community Plan of Pennsylvania
Genicular Nerve RFA at UnitedHealthcare Community Plan of Pennsylvania.
How UnitedHealthcare Community Plan of Pennsylvania 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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UHC CP-PA Provider ManualCriteria summary
High-level themes from the UnitedHealthcare Community Plan of Pennsylvania 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) (CPT 64454) documentation required (typically with ≥50% relief).
Source: UnitedHealthcare Community Plan of Pennsylvania — Care Provider Manual (HealthChoices, 2025/2026)
See the full UnitedHealthcare Community Plan of Pennsylvania criteria.
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