CPT 64625 · SI Joint · Priority Partners MCO
SI Joint RFA (lateral branches) at Priority Partners MCO.
How Priority Partners MCO approaches CPT 64625 (SI Joint RFA (lateral branches)) for prior-authorization review: at last review on 2026-04-27, the policy does not cover this code with prior authorization required.
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eviCore CMM-203Criteria summary
High-level themes from the Priority Partners MCO 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: JHHC / eviCore CMM-203 — Sacroiliac Joint Procedures (Priority Partners)
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