Rubrica

CPT 64629 · Intradiscal · Ohio Medicaid

Intracept — BVN Ablation (add'l) at Ohio Medicaid.

How Ohio Medicaid approaches CPT 64629 (Intracept — BVN Ablation (add'l)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.

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Coverage Covered
Prior auth Prior auth required
Last reviewed 2026-05-06

Criteria summary

High-level themes from the Ohio Medicaid policy of record for CPT 64629. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: Ohio Medicaid Interventional Pain Management Coverage Guidelines

See the full Ohio Medicaid criteria.

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