64629 prior authorization | Anthem Blue Cross Blue Shield of California

64629, Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure), is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 64629
Description: Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
Source: California PPO Prior Authorization List, Pg 43 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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