CPT 64628 · Intradiscal · Sunshine Health (Centene) — Florida Medicaid
Intracept — Basivertebral Nerve Ablation (1st level) at Sunshine Health (Centene) — Florida Medicaid.
How Sunshine Health (Centene) — Florida Medicaid approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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InterQual / FL 59G-4.222 (silent)Criteria summary
High-level themes from the Sunshine Health (Centene) — Florida Medicaid 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.
See the full Sunshine Health (Centene) — Florida Medicaid criteria.
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