Facet Joint Interventions for Pain Management
J15 · Effective May 2, 2021
22 active Medicare policies list 64490, and 16 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective May 2, 2021
J9 · Effective Oct 1, 2015
J9
J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
JE · Effective Apr 25, 2021
JF · Effective Apr 25, 2021
JH · Effective Oct 1, 2015
JH
16 policies from 14 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 64490 |
|---|---|---|
| Aetna Interventional Pain Code List | Jan 1, 2025 | Prior auth required |
| Blood and Adipose Tissue Derived Products for Selected Indications | Oct 26, 2023 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Cigna Commercial Interventional Pain Management Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
JL · Effective Oct 1, 2015
JJ · Effective Apr 25, 2021
JM · Effective Apr 25, 2021
J5 · Effective Apr 25, 2021
J8 · Effective Apr 25, 2021
JL · Effective Jan 5, 2026
J9 · Effective Jan 5, 2026
J6 · Effective Sep 17, 2026
National · Effective Sep 17, 2026
National · Effective Sep 17, 2026
National · Effective Sep 17, 2026
J5 · Effective Sep 17, 2026
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint Interventions | Not recorded | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint Injections | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint Injections | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint Injections | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint Injections | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Interventional Pain Management | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Cigna Medicare Advantage Interventional Pain Management Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of 64490 |
|---|---|---|
| EOCCO Pain Management Code List | May 1, 2026 | Prior auth required |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Health Alliance Plan MSK Code List | Jan 1, 2026 | Prior auth required |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint and Medial Branch Block Injections for Spinal Pain – Surest Medical Policy | Sep 10, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint and Medial Branch Block Injections for Spinal Pain | Sep 10, 2026 | Covered |
| Policy | Effective | Status of 64490 |
|---|---|---|
| Facet Joint and Medial Branch Block Injections for Spinal Pain | Sep 10, 2026 | Covered |