CPT 64636 · RFA · Highmark Wholecare — PA HealthChoices
RFA — Lumbar/Sacral Facet (add'l level) at Highmark Wholecare — PA HealthChoices.
How Highmark Wholecare — PA HealthChoices approaches CPT 64636 (RFA — Lumbar/Sacral Facet (add'l 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
HealthHelp IPM — Facet Joint Radiofrequency AblationCriteria summary
High-level themes from the Highmark Wholecare — PA HealthChoices policy of record for CPT 64636. 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 Two diagnostic facet/medial-branch blocks at target level (cervical/thoracic 64490/64491; lumbar 64493/64494) documentation required (typically with ≥80% relief).
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