New Preauthorization Requirements Starting Aug. 15, 2025

Date Posted: 06/04/2025

The following codes are being added to our preauthorization list effective Aug. 15, 2025.

Codes Added to Preauthorization List Starting Aug. 15, 2025

CPT/HCPCS Code

CPT Code Description

64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

64629

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)

 

The following codes were removed from our preauthorization list effective Jan. 1, 2025.

Codes Removed From Preauthorization List Starting Jan. 1, 2025

CPT/HCPCS Code CPT Code Description

E0737

Transcutaneous tibial nerve stimulator, controlled by phone application

A4545

Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month

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