64634 prior authorization | Anthem Blue Cross and Blue Shield Virginia

64634, Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Cervical Or Thoracic, Each Additional Facet Joint (List Separat, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO 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 Separat
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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