CPT 64634 · RFA · Medicare (CGS MAC)
RFA — Cervical/Thoracic Facet (add'l level) at Medicare (CGS MAC).
How Medicare (CGS MAC) approaches CPT 64634 (RFA — Cervical/Thoracic Facet (add'l level)) for prior-authorization review: at last review on 2026-05-09, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-09
Policy number
L38773Criteria summary
High-level themes from the Medicare (CGS MAC) policy of record for CPT 64634. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
- Prior Diagnostic medial branch block (MBB) or intra-articular facet injection documentation required (typically with ≥80% relief).
Source: LCD L38773 — Facet Joint Interventions for Pain Management (CGS)
See the full Medicare (CGS MAC) criteria.
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