64629 prior authorization | Anthem Blue Cross Blue Shield of Georgia

64629, Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral, is on the Anthem Blue Cross Blue Shield of Georgia 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
Source: Standard Local Prior Authorization Code List, Pg 29 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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