Does 62264 require prior authorization?

No, 62264 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 62264?

Medicare facility rate: $214.10. Non-facility rate: $446.57. Work RVU: 4.31.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

4.31

Facility

$214.10

Non-Facility

$446.57

The policy does not specify particular medical-record documentation (e.g., required test results or clinical notes) that would render these procedures covered; instead, it states they are unproven and not medically necessary.
General instruction: When deciding coverage, reference the member-specific benefit plan document and any applicable federal or state mandates; in the event of conflict, the member-specific plan governs.
If this policy is applied to Medicare Advantage in absence of an NCD/LCD, MAO coverage determinations should rely on objective evidence-based rationale and authoritative evidence (Medicare IOM Pub. No. 100-16, Ch. 4, §90.5).
Coding note/documentation: Functional anesthetic discography should be billed with CPT code 64999 (billing clarification provided).

Epiduroscopy / epidural lysis of adhesions: proposed for diagnosis/treatment of intractable LBP (including failed back surgery syndrome) by visualizing and lysing adhesions and injecting medications (insufficient high-quality evidence to support routine clinical use).
Kyphoplasty (balloon-assisted vertebroplasty): restore bone height for painful osteoporotic compression fractures (OVCFs); NICE and other assessments note kyphoplasty may be a reasonable alternative to vertebroplasty for recent fractures.
Sacropasty: injection of PMMA into sacrum for sacral insufficiency fractures (SIFs) in osteoporotic patients to stabilize fracture and relieve pain (developing indication).
Vesselplasty: image-guided procedure using a containment device and PMMA to treat symptomatic vertebral compression fractures to reduce cement leakage (investigational/promise shown but limited evidence).
Microsurgical anterior foraminotomy: proposed for intractable cervical radiculopathy to remove herniated disc or bone spur via anterior approach without fusion (insufficient high-quality evidence).
Open sacroiliac fusion: proposed for SIJ dysfunction/syndrome when other non-operative treatments failed; evidence insufficient to support routine use.

AMBETTER-CP.MP.116 — Lysis of Epidural Lesions

UHC-POL-epiduroscopy-epidural-lysis-adhesions-discography — Epiduroscopy, Epidural Lysis of Adhesions, and Discography

UMR-POL-UMR-epiduroscopy-epidural-lysis-adhesions-discography — Epiduroscopy, Epidural Lysis of Adhesions, and Discography

SUREST-POL-SUREST-epiduroscopy-epidural-lysis-adhesions-discography — Epiduroscopy, Epidural Lysis of Adhesions, and Discography

Ask Verity about documentation requirements, denial risks, or coverage in your state.