CPT 64628 · BVN Ablation · BCBS Tennessee
Intracept — Basivertebral Nerve Ablation (1st level) at BCBS Tennessee.
How BCBS Tennessee approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2026-04-27, the policy does not cover this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
BCBS-TN MPM (Investigational Services default)Criteria summary
High-level themes from the BCBS Tennessee 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: BCBS-TN Investigational Services (default for unaddressed novel procedures)
See the full BCBS Tennessee 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 →