Intraosseous Basivertebral Nerve Ablation
JE · Effective Jan 28, 2024
11 active Medicare policies list 64628, and 15 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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JE · Effective Jan 28, 2024
JF · Effective Jan 28, 2024
J6
J6 · Effective Jul 15, 2026
JK
JK · Effective Jul 15, 2026
JJ · Effective Mar 5, 2023
JM · Effective Mar 5, 2023
15 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 64628 |
|---|---|---|
| Cigna Commercial Spine Surgery Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Back Pain - Invasive Procedures | Mar 13, 2024 | Covered |
| Policy | Effective | Status of 64628 |
|---|
National · Effective Mar 5, 2026
National · Effective Mar 5, 2023
National · Effective Jul 15, 2026
| Nerve Blocks and Neurolysis for Pain Management | Not recorded | Covered |
|---|
| Policy | Effective | Status of 64628 |
|---|---|---|
| Percutaneous Vertebral Disc Procedures | Jul 1, 2026 | Not covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Intraosseous Radiofrequency Nerve Ablation of the Basivertebral Nerve for the Treatment of Low Back Pain | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Intraosseous Radiofrequency Nerve Ablation of the Basivertebral Nerve for the Treatment of Low Back Pain | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Intraosseous Radiofrequency Nerve Ablation of the Basivertebral Nerve for the Treatment of Low Back Pain | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Intraosseous Radiofrequency Nerve Ablation of the Basivertebral Nerve for the Treatment of Low Back Pain | Sep 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Interventional Pain Management | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Intraosseous Radiofrequency Ablation of the Basivertebral Nerve | Mar 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Ablative Treatment for Spinal Pain – Surest Medical Policy | May 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Ablative Treatment for Spinal Pain | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Ablative Treatment for Spinal Pain | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 64628 |
|---|---|---|
| Pain Management | Not recorded | Covered |