CPT 64633 · RFA · Horizon BCBS NJ
RFA — Cervical/Thoracic Facet (1st level) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) for prior-authorization review: at last review on 2026-05-11, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
158Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ policy of record for CPT 64633. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic facet joint injection or MBB documentation required (typically with ≥80% relief).
Source: Horizon BCBSNJ Medical Policy 158 — Radiofrequency Joint Ablation/Denervation
See the full Horizon BCBS NJ criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →