64634 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

64634, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (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: 64634
Description: Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (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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