CPT 64628 · BVN Ablation · Ambetter
Intracept — Basivertebral Nerve Ablation (1st level) at Ambetter.
How Ambetter approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2024-09-01, the policy does not cover this code with prior authorization required.
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CP.MP.170Criteria summary
High-level themes from the Ambetter policy of record for CPT 64628. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: Ambetter Centene CP.MP.170: Nerve Blocks for Pain Management
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