Rubrica

CPT 64628 · Intradiscal · UnitedHealthcare Community Plan of Florida

Intracept — Basivertebral Nerve Ablation (1st level) at UnitedHealthcare Community Plan of Florida.

How UnitedHealthcare Community Plan of Florida approaches CPT 64628 (Intracept — Basivertebral Nerve Ablation (1st level)) for prior-authorization review: at last review on 2026-05-06, 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 2026-05-06
Policy number2026T0107II

Criteria summary

High-level themes from the UnitedHealthcare Community Plan of Florida 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: UHC Community Plan of Florida — adopts UHC Commercial/Individual Exchange — Ablative Treatment for Spinal Pain

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