CPT 64628 · BVN Ablation · BCBS Illinois
Intracept — Basivertebral Nerve Ablation (1st level) at BCBS Illinois.
How BCBS Illinois approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2024-10-28, the policy covers this code without prior authorization.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
No prior auth
Last reviewed
2024-10-28
Policy number
MSK01-0725.1v2Criteria summary
High-level themes from the BCBS Illinois policy of record for CPT 64628. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 26 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full BCBS Illinois criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →