Prior Auth Required

64628 - Basivertebral nerve ablation – destruction CPT , All

This procedure appears on the selected insurer prior authorization source.

Prior authorizationPrior Auth Required
Procedure / ServiceBasivertebral nerve ablation – destruction CPT , All
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - Rectal control system for vaginal insertion (long term use) A4563 All Bronchoscopy with microwave ablation and full image guided navigation bundle C9751 All Basivertebral nerve ablation – destruction CPT 64628, 64629 All EoE biomarker ELISA (eotaxin 3, PRG2) with algorithm 0095U All Hereditary colon cancer panel with mRNA analytics (15+ genes) 0101U All

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.