64636 prior authorization | Anthem Blue Cross and Blue Shield Virginia
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 Virginia HMO/EPO 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
- Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 26 Original policy
Anthem Blue Cross and Blue Shield Virginia prior authorization