CPT 64628 · BVN Ablation · Excellus BCBS
Intracept — Basivertebral Nerve Ablation (1st level) at Excellus BCBS.
How Excellus BCBS 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.
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Coverage
Not covered
Prior auth
Prior auth required
InvestigationalInvestigational / experimental
Last reviewed
2026-04-27
Policy number
7.01.42Criteria summary
High-level themes from the Excellus BCBS 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.
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