CPT 64625 · SI Joint · UnitedHealthcare Community Plan of Maryland
SI Joint RFA (lateral branches) at UnitedHealthcare Community Plan of Maryland.
How UnitedHealthcare Community Plan of Maryland 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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2026T0621NCriteria summary
High-level themes from the UnitedHealthcare Community Plan of Maryland 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: UHC Community Plan of Maryland — adopts UHC Commercial Sacroiliac Joint Interventions Medical Policy
See the full UnitedHealthcare Community Plan of Maryland criteria.
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