Prior Auth Required

64624 - performed

This procedure appears on the selected insurer prior authorization source.

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Procedure / Serviceperformed
Procedure / Service Description

Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when - 64610 Destruction, Neurolytic, Trigeminal Nerve; 2nd & 3rd Division W/Radiologic Monitoring Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when 64624 performed Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, 64625 fluoroscopy or computed tomography)

Likely documents
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  • Submit clinical notes if requested by the plan
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