CPT 64625 · Decompression · Georgia Medicaid
SI Joint RFA (lateral branches) at Georgia Medicaid.
How Georgia Medicaid approaches CPT 64625 (SI Joint RFA (lateral branches)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the Georgia Medicaid 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: Georgia Medicaid Coverage Policy - Interventional Pain Procedures
See the full Georgia Medicaid criteria.
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