CPT 64625 · SI Joint · Wellpoint of New Jersey — NJ Medicaid
SI Joint RFA (lateral branches) at Wellpoint of New Jersey — NJ Medicaid.
How Wellpoint of New Jersey — NJ Medicaid 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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Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint of New Jersey — NJ Medicaid policy of record for CPT 64625. Verbatim policy text and per-criterion analysis are available after sign-in.
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