CPT 64635 · RFA · Independence Blue Cross
RFA — Lumbar/Sacral Facet (1st level) at Independence Blue Cross.
How Independence Blue Cross approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2026-06-14, the policy covers this code with prior authorization required.
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Carelon-IPM-2026-06-14Criteria summary
High-level themes from the Independence Blue Cross 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 Dual MBBs within 6 months documentation required (typically with ≥80% relief).
Source: Carelon Interventional Pain Management 2026 (IBX delegated UM)
See the full Independence Blue Cross criteria.
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