CPT 64635 · RFA · BCBS Alabama
RFA — Lumbar/Sacral Facet (1st level) at BCBS Alabama.
How BCBS Alabama approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2024-12-01, the policy covers this code with prior authorization required.
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BCBS-AL MP-141Verification 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 BCBS Alabama policy of record for CPT 64635. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Prior Successful trial of controlled diagnostic medial branch blocks (2 separate positive blocks) documentation required (typically with ≥50% relief).
Source: BCBS Alabama Medical Policy MP-141 Facet Joint Denervation
See the full BCBS Alabama criteria.
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