Cigna Prior Authorization for CPT 64490

Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only) in PA

Reviewed by D3rx Clinical Billing Team
Last updated: March 29, 2026
Prior Authorization Required

Documents Needed

  • Clinical notes

Clinical Criteria

Spinal and peripheral injections of anesthetic agents and/or steroids including transforaminal epidural, paravertebral facet joint, sacroiliac joint, and sympathetic nerve blocks with imaging guidance

Source: Cigna Prior Authorization List

Submission Tips

Document medical necessity thoroughly before submitting. Include clinical notes, relevant test results, and a clear rationale for why CPT 64490 is appropriate for the patient's condition.

About CPT 64490

CPT 64490Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only). Prior authorization requirements vary by payer, plan type, and state. Cigna requires prior authorization for this procedure in PA.

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CPT 64490 with Other Payers

Medical Billing Disclaimer

The information provided on this page is for educational and informational purposes only. While we strive to maintain the most current and accurate prior authorization data, requirements change frequently and vary by individual plan type. Always verify prior authorization requirements directly with the payer before performing a procedure. D3rx is not responsible for any claim denials or reimbursement issues.