CPT 64634 · RFA · Community Care Plan — Florida Medicaid
RFA — Cervical/Thoracic Facet (add'l level) at Community Care Plan — Florida Medicaid.
How Community Care Plan — Florida Medicaid approaches CPT 64634 (RFA — Cervical/Thoracic Facet (add'l level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-06
Policy number
59G-4.222 / L33930Criteria summary
High-level themes from the Community Care Plan — Florida Medicaid policy of record for CPT 64634. Verbatim policy text and per-criterion analysis are available after sign-in.
- Conservative care expectations vary; sign in for specifics.
- Imaging concordance documentation required.
- Prior Diagnostic temporary block (medial branch block / facet block) under fluoroscopic guidance documentation required (typically with ≥50% relief).
See the full Community Care Plan — Florida Medicaid criteria.
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