64636 prior authorization | Anthem Blue Cross and Blue Shield Nevada

64636, Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral, Each Additional Facet Joint (List Separately, is on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage or referral decision.

Code: 64636
Description: Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral, Each Additional Facet Joint (List Separately
Source: Nevada Prior Authorization List, Pg 72 Original policy

Anthem Blue Cross and Blue Shield Nevada prior authorization

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