64490 prior authorization | Anthem Blue Cross Blue Shield of Georgia

64490, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 64490
Description: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
Source: Standard Local Prior Authorization Code List, Pg 28 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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