CPT 64628 · Intradiscal
Intracept — Basivertebral Nerve Ablation (1st level)
Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral.
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Rubrica tracks payor coverage for CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) across 114 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 64628
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | No PA |
| Aetna Better Health Medicaid | Covered | No PA |
| Aetna Better Health of Florida | Covered | No PA |
| Aetna Better Health of Maryland | Covered | No PA |
| Aetna Better Health of New Jersey | Covered | No PA |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| Ambetter | Covered | No PA |
| AmeriHealth Caritas | Covered | No PA |
Coverage themes for CPT 64628
Common patterns across the 114 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥26 weeks of conservative care before approving 64628.
59 of 114 payors require imaging concordance documentation.
Of the 114 payors with coverage records for CPT 64628, 79 require prior authorization, 3 cover without prior authorization, and 25 flag the procedure as investigational or experimental under current criteria.
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