CPT 64633 · RFA · Medicare (WPS MAC)
RFA — Cervical/Thoracic Facet (1st level) at Medicare (WPS MAC).
How Medicare (WPS MAC) approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) for prior-authorization review: at last review on 2026-05-03, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-03
Policy number
L38841Criteria summary
High-level themes from the Medicare (WPS MAC) 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 medial branch blocks (CPT 64490/64491) documentation required (typically with ≥80% relief).
Source: WPS LCD L38841 — Facet Joint Interventions for Pain Management
See the full Medicare (WPS MAC) criteria.
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