64633 prior authorization | Premera Blue Cross of Washington

64633, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 64633
Description: Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
Source: Clinical Review by Code List PBCWA, Pg 381 Original policy

Premera Blue Cross of Washington prior authorization

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