CPT 64635 · RFA · UPMC for You — PA HealthChoices
RFA — Lumbar/Sacral Facet (1st level) at UPMC for You — PA HealthChoices.
How UPMC for You — PA HealthChoices approaches CPT 64635 (RFA — Lumbar/Sacral Facet (1st level)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
L34892Criteria summary
High-level themes from the UPMC for You — PA HealthChoices policy of record for CPT 64635. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
- Prior Diagnostic medial branch block (MBB) or intra-articular facet injection documentation required (typically with ≥80% relief).
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