CPT 64633 · RFA · Horizon NJ Health — NJ Medicaid
RFA — Cervical/Thoracic Facet (1st level) at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid 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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158Criteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid 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/MBB (CPT 64490/64491) documentation required (typically with ≥80% relief).
Source: Horizon BCBSNJ Medical Policy 158 — Radiofrequency Joint Ablation/Denervation
See the full Horizon NJ Health — NJ Medicaid criteria.
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