64628 prior authorization | Anthem Blue Cross and Blue Shield Virginia

64628, Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 64628
Description: Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 26 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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