CPT 64634 · RFA · BCBS Tennessee
RFA — Cervical/Thoracic Facet (add'l level) at BCBS Tennessee.
How BCBS Tennessee approaches CPT 64634 (RFA — Cervical/Thoracic Facet (add'l level)) for prior-authorization review: at last review on 2026-01-30, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-01-30
Policy number
BCBS-TN MPM (Facet Joint Neurotomy)Criteria summary
High-level themes from the BCBS Tennessee policy of record for CPT 64634. 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 successful diagnostic MBBs documentation required (typically with ≥80% relief).
See the full BCBS Tennessee criteria.
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