CPT 64628 · Intradiscal · Medicare (Novitas MAC) — TX
Intracept — Basivertebral Nerve Ablation (1st level) at Medicare (Novitas MAC) — TX.
How Medicare (Novitas MAC) — TX approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Clearway-MPG-IntraceptCriteria summary
High-level themes from the Medicare (Novitas MAC) — TX 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: Clearway Master Payer Guidelines v2025 — Intracept
See the full Medicare (Novitas MAC) — TX criteria.
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