CPT 64629 · BVN Ablation · BCBS Illinois
Intracept — BVN Ablation (add'l) at BCBS Illinois.
How BCBS Illinois approaches CPT 64629 (Intracept — BVN Ablation (add'l)) for prior-authorization review: at last review on 2024-10-28, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2024-10-28
Policy number
MSK01-0725.1v2Criteria summary
High-level themes from the BCBS Illinois policy of record for CPT 64629. 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 BCBS Illinois criteria.
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