Rubrica

CPT 64628 · BVN Ablation · Johns Hopkins HealthCare (Employer Health)

Intracept — Basivertebral Nerve Ablation (1st level) at Johns Hopkins HealthCare (Employer Health).

How Johns Hopkins HealthCare (Employer Health) approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2025-12-18, 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 2025-12-18
Policy numbereviCore CMM-208

Criteria summary

High-level themes from the Johns Hopkins HealthCare (Employer Health) 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: JHHC eviCore CMM-208 (BVN ablation EIU)

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