CPT 64635 · RFA · Highmark BCBS
RFA — Lumbar/Sacral Facet (1st level) at Highmark BCBS.
How Highmark BCBS approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2026-04-26, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-26
Policy number
eviCore CMM-208 (Highmark)Criteria summary
High-level themes from the Highmark BCBS policy of record for CPT 64635. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic medial branch block (MBB) documentation required (typically with ≥80% relief).
Source: Highmark Commercial Prior-Auth List — eviCore MSK delegation
See the full Highmark BCBS criteria.
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