Prior Auth Required

64640 - Radiofrequency denervation/neurolysis – facet or SI joint (thoracic/SI require authorization) , , , , , , All

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceRadiofrequency denervation/neurolysis – facet or SI joint (thoracic/SI require authorization) , , , , , , All
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - Neurostimulator additions (electrodes, generators, etc.) L8679, L8680, L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689, L8695 All Posterior intrafacet implant(s) placement 0219T, 0221T, 0222T All Radiofrequency denervation/neurolysis – facet or SI joint (thoracic/SI require authorization) 64620, 64624, 64625, 64632, 64640, 64633, 64634 All Corneal shape altering procedures 65760, 65765, 65767, 65770 All Correction of surgically induced astigmatism 65772, 65775 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.