CPT 64635 · RFA · UnitedHealthcare Medicare Advantage
RFA — Lumbar/Sacral Facet (1st level) at UnitedHealthcare Medicare Advantage.
How UnitedHealthcare Medicare Advantage approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2026-05-08, the policy covers this code with prior authorization required.
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Criteria summary
High-level themes from the UnitedHealthcare Medicare Advantage 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 Two diagnostic medial branch blocks (CPT 64493/64494) documentation required (typically with ≥80% relief).
Source: UnitedHealthcare Medicare Advantage Medical Policy (National)
See the full UnitedHealthcare Medicare Advantage criteria.
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