CPT 64633 · RFA · UnitedHealthcare (Commercial)
RFA — Cervical/Thoracic Facet (1st level) at UnitedHealthcare (Commercial).
How UnitedHealthcare (Commercial) approaches CPT 64633 (RFA — Cervical/Thoracic Facet (1st level)) for prior-authorization review: at last review on 2026-04-24, the policy covers this code with prior authorization required.
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2026T0107IICriteria summary
High-level themes from the UnitedHealthcare (Commercial) 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 Diagnostic medial branch blocks (CPT 64490 series) documentation required (typically with ≥50% relief).
Source: UHC Commercial — Ablative Treatment for Spinal Pain (+ Facet/MBB prerequisite)
See the full UnitedHealthcare (Commercial) criteria.
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