CPT 64629 · Intradiscal · Medicare (WPS MAC)
Intracept — BVN Ablation (add'l) at Medicare (WPS MAC).
How Medicare (WPS MAC) approaches CPT 64629 (Intracept — BVN Ablation (add'l)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-26
Policy number
Clearway-MPG-IntraceptCriteria summary
High-level themes from the Medicare (WPS MAC) 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: Clearway Master Payer Guidelines v2025 — Intracept
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