64494 prior authorization | Anthem Blue Cross Blue Shield of Georgia
64494, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.
- Code
- 64494
- Description
- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level
- Source
- Standard Local Prior Authorization Code List, Pg 28 Original policy
Anthem Blue Cross Blue Shield of Georgia prior authorization