64635 prior authorization | Blue Cross and Blue Shield of Montana

64635, Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral Single Facet Joint, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 64635
Description: Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral Single Facet Joint
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 69 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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