CPT 64636 · RFA · MedStar Family Choice — Maryland Medicaid
RFA — Lumbar/Sacral Facet (add'l level) at MedStar Family Choice — Maryland Medicaid.
How MedStar Family Choice — Maryland Medicaid 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 without prior authorization.
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L34892Criteria summary
High-level themes from the MedStar Family Choice — Maryland Medicaid 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: Maryland Medicaid Professional Services Provider Manual & Fee Schedule (FFS)
See the full MedStar Family Choice — Maryland Medicaid criteria.
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