CPT 64629 · BVN Ablation · Highmark BCBS
Intracept — BVN Ablation (add'l) at Highmark BCBS.
How Highmark BCBS approaches CPT 64629 (Intracept — BVN Ablation (add'l)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-26
Policy number
Z-104Criteria summary
High-level themes from the Highmark BCBS 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.
Source: Highmark Medical Policy Z-104 — Basivertebral Nerve Ablation
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