CPT 64628 · BVN Ablation · BCBS Massachusetts
Intracept — Basivertebral Nerve Ablation (1st level) at BCBS Massachusetts.
How BCBS Massachusetts approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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MP — Intraosseous BVN AblationCriteria summary
High-level themes from the BCBS Massachusetts 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.
Source: BCBSMA MP — Intraosseous Basivertebral Nerve Ablation (Intracept)
See the full BCBS Massachusetts criteria.
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