64629 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

64629, Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 64629
Description: Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 138 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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