CPT 64628 · BVN Ablation · GEHA
Intracept — Basivertebral Nerve Ablation (1st level) at GEHA.
How GEHA approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2025-12-02, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-12-02
Policy number
GEHA Coverage Policy - BVNCriteria summary
High-level themes from the GEHA policy of record for CPT 64628. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full GEHA criteria.
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