CPT 64636 · RFA · Humana Healthy Horizons in Florida
RFA — Lumbar/Sacral Facet (add'l level) at Humana Healthy Horizons in Florida.
How Humana Healthy Horizons in Florida 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
HUM-0387-024 / 59G-4.222 / L33930Criteria summary
High-level themes from the Humana Healthy Horizons in Florida policy of record for CPT 64636. Verbatim policy text and per-criterion analysis are available after sign-in.
- Conservative care expectations vary; sign in for specifics.
- Imaging concordance documentation required.
- Prior Diagnostic temporary block (medial branch block / facet block) under fluoroscopic guidance documentation required (typically with ≥50% relief).
See the full Humana Healthy Horizons in Florida criteria.
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