CPT 64625 · SI Joint · UnitedHealthcare Community Plan of Pennsylvania
SI Joint RFA (lateral branches) at UnitedHealthcare Community Plan of Pennsylvania.
How UnitedHealthcare Community Plan of Pennsylvania approaches CPT 64625 (SI Joint RFA (lateral branches)) for prior-authorization review: at last review on 2026-05-06, the policy does not cover this code with prior authorization required.
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UHC CP-PA Medicaid: Ablation Procedures (eff 2025-06-01)Criteria summary
High-level themes from the UnitedHealthcare Community Plan of Pennsylvania policy of record for CPT 64625. Verbatim policy text and per-criterion analysis are available after sign-in.
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