CPT 64633 · RFA · Geisinger Health Plan — PA HealthChoices
RFA — Cervical/Thoracic Facet (1st level) at Geisinger Health Plan — PA HealthChoices.
How Geisinger Health Plan — PA HealthChoices approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) 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
Policy number
Cohere Pain — RFA / Novitas L34892 floorCriteria summary
High-level themes from the Geisinger Health Plan — PA HealthChoices policy of record for CPT 64633. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Two diagnostic medial branch blocks (MBB) at same level/side documentation required (typically with ≥80% relief).
See the full Geisinger Health Plan — PA HealthChoices criteria.
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