CPT 64628 · Intradiscal · UnitedHealthcare Community Plan of Maryland
Intracept — Basivertebral Nerve Ablation (1st level) at UnitedHealthcare Community Plan of Maryland.
How UnitedHealthcare Community Plan of Maryland 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.
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2026T0107IICriteria summary
High-level themes from the UnitedHealthcare Community Plan of Maryland policy of record for CPT 64628. Verbatim policy text and per-criterion analysis are available after sign-in.
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