64628 prior authorization | Anthem Blue Cross Blue Shield of California

64628, Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral, is on the Anthem Blue Cross Blue Shield of California PPO 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: California PPO Prior Authorization List, Pg 43 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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