CPT 64636 · RFA · Horizon BCBS NJ
RFA — Lumbar/Sacral Facet (add'l level) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 64636 (RFA — Lumbar/Sacral Facet (add'l level)) for prior-authorization review: at last review on 2026-05-11, the policy covers this code with prior authorization required.
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158Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ policy of record for CPT 64636. 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 Dual diagnostic blocks documentation required (typically with ≥80% relief).
See the full Horizon BCBS NJ criteria.
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