CPT 64636 · RFA · Medicare (NGS MAC)
RFA — Lumbar/Sacral Facet (add'l level) at Medicare (NGS MAC).
How Medicare (NGS MAC) approaches CPT 64636 (RFA — Lumbar/Sacral Facet (add'l level)) for prior-authorization review: at last review on 2026-05-09, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-09
Policy number
L35936Criteria summary
High-level themes from the Medicare (NGS MAC) policy of record for CPT 64636. 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).
Source: LCD L35936 — Facet Joint Interventions for Pain Management (NGS)
See the full Medicare (NGS MAC) criteria.
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