CPT 64629 · Intradiscal · Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid
Intracept — BVN Ablation (add'l) at Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid.
How Simply Healthcare Plans (Anthem/Elevance) — Florida 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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SURG.00052Criteria summary
High-level themes from the Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid 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: Anthem Medical Policy SURG.00052 — Percutaneous Vertebral Disc and Vertebral Endplate Procedures
See the full Simply Healthcare Plans (Anthem/Elevance) — Florida Medicaid criteria.
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