Prior Auth Required

64575 - ( , , , , , ) is considered experimental for any indication

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service( , , , , , ) is considered experimental for any indication
Procedure / Service Description

POLICY NAME: PAIN MANAGEMENT SERVICES - criteria. • Percutaneous peripheral nerve stimulation (PNS), Peripheral nerve field stimulation (PNFS) (64555, 64575, 64590, 64595, 64999, 64567) is considered experimental for any indication. • Prolotherapy (M0076) • Radiofrequency denervation (ablation) of the nerves that innervate the sacroiliac joint (L5,

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.