CPT 64635 · RFA · BCBS Federal Employee Program
RFA — Lumbar/Sacral Facet (1st level) at BCBS Federal Employee Program.
How BCBS Federal Employee Program approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-04-27
Policy number
FEP 7.01.116Criteria summary
High-level themes from the BCBS Federal Employee Program 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.
- Imaging concordance documentation required.
- Prior Diagnostic medial branch block (64493) documentation required (typically with ≥80% relief).
See the full BCBS Federal Employee Program criteria.
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