CPT 64625 · SI Joint · Wellpoint Maryland
SI Joint RFA (lateral branches) at Wellpoint Maryland.
How Wellpoint 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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Coverage
Not covered
Prior auth
Prior auth required
InvestigationalInvestigational / experimental
Last reviewed
2026-04-27
Policy number
Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint 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.
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