Prior Authorization
Blue Cross NC Prior Authorization for CPT 64635
Site of service - Neurologic procedures (outpatient hospital/ASC only) · Standard commercial plans
Source
Blue Cross NC Commercial CPT/HCPCS Prior Plan Approval SearchNot medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Blue Cross NC commercial CPT/HCPCS prior plan approval search lists 64635 as requiring prior approval for North Carolina commercial context, current as of 2026-05-09. Program label(s): MSK. Source description(s): Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance(fluroscopy or CT);Lumbar or sacral, single facet joint. Source note(s): EFFECTIVE 7/1/25 service also reviewed for Site of Care (SOC). Verify member benefits, BlueCard/home-plan context, FEP, Medicare, Medicaid, and program-specific requirements before submission. This listing is not a payment, coverage, or medical-necessity guarantee.
Documentation checklist
- ✓Member benefit and eligibility verification
- ✓Blue Cross NC program-specific prior plan approval documentation
- ✓Clinical records supporting the requested service when requested by Blue Cross NC or its vendor
2026 Medicare rate for CPT 64635
Office (non-facility)
$464.94
Facility
$173.02
Total RVUs (office)
13.92
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Blue Cross NC's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 64635 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Member benefit and eligibility verification, Blue Cross NC program-specific prior plan approval documentation, Clinical records supporting the requested service when requested by Blue Cross NC or its vendor.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Blue Cross NC require prior authorization for CPT 64635?
- Yes. Blue Cross NC requires prior authorization for CPT 64635 (Site of service - Neurologic procedures (outpatient hospital/ASC only)) under Standard commercial plans per its published clinical policy.
- What documentation does Blue Cross NC require for CPT 64635?
- Member benefit and eligibility verification; Blue Cross NC program-specific prior plan approval documentation; Clinical records supporting the requested service when requested by Blue Cross NC or its vendor
- How much does Medicare pay for CPT 64635 in 2026?
- In 2026, the national Medicare allowable for CPT 64635 is $464.94 in an office setting and $173.02 in a facility. Commercial allowables for Blue Cross NC are typically negotiated against this benchmark.
- What if Blue Cross NC denies the PA for CPT 64635?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Blue Cross NC PA lookups
CPT 64635 prior authorization by payer
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