RFA — Cervical/Thoracic Facet (1st level) at Cigna.
How Cigna approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) 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
CMM-208Criteria summary
High-level themes from the Cigna policy of record for CPT 64633. Verbatim policy text and per-criterion analysis are available after sign-in.
- Prior Diagnostic medial branch block (MBB) documentation required (typically with ≥80% relief).
Source: Cigna CMM-208 (eviCore CMM)
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