CPT 64628 · BVN Ablation · Medicare (Palmetto GBA MAC)
Intracept — Basivertebral Nerve Ablation (1st level) at Medicare (Palmetto GBA MAC).
How Medicare (Palmetto GBA MAC) 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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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-26
Policy number
L39420Criteria summary
High-level themes from the Medicare (Palmetto GBA MAC) 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 Medicare (Palmetto GBA MAC) criteria.
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