CPT 64625 · SI Joint · CareFirst BCBS Community Health Plan Maryland (CHPMD)
SI Joint RFA (lateral branches) at CareFirst BCBS Community Health Plan Maryland (CHPMD).
How CareFirst BCBS Community Health Plan Maryland (CHPMD) approaches CPT 64625 (SI Joint RFA (lateral branches)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.
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Criteria summary
High-level themes from the CareFirst BCBS Community Health Plan Maryland (CHPMD) policy of record for CPT 64625. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Maryland Medicaid Professional Services Provider Manual & Fee Schedule (FFS)
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