RFA — Cervical/Thoracic Facet (1st level) at Tricare.
How Tricare approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) for prior-authorization review: at last review on 2024-01-01, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2024-01-01
Verification 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 Tricare 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 Two diagnostic medial branch blocks (CPT 64490/64491) documentation required (typically with ≥80% relief).
See the full Tricare 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 →