CPT 64628 · Intradiscal · Priority Partners MCO
Intracept — Basivertebral Nerve Ablation (1st level) at Priority Partners MCO.
How Priority Partners MCO 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
eviCore CMM-208Criteria summary
High-level themes from the Priority Partners MCO 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 V2.0.2025 — Facet Ablation (incl. BVN EIU section, Priority Partners)
See the full Priority Partners MCO criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →