64495 prior authorization | Anthem Blue Cross Blue Shield of Georgia

64495, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s), is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 64495
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; third and any additional level(s)
Source: Standard Local Prior Authorization Code List, Pg 28 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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