Prior Authorization
Humana Prior Authorization for CPT 64493
Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only) · Standard commercial plans
Source
Humana Commercial Preauthorization and Notification List (July 2024)Not 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
Humana requires prior authorization for facet joint injection (64493). Axial spine pain consistent with facet origin, no radicular symptoms. Must have failed 4-6 weeks conservative therapy before diagnostic blocks. Positive diagnostic block (>=50% relief) required before therapeutic injection. Fluoroscopic guidance mandatory. Limited to 3 per region per 12 months.
Documentation checklist
- ✓Clinical notes documenting axial pain pattern without radiculopathy
- ✓Conservative treatment documentation (4-6 weeks)
- ✓Prior diagnostic block results with pain relief percentage (for therapeutic requests)
- ✓Imaging guidance confirmation (fluoroscopy)
Submission channels
Phone
1-800-444-9137Fax
1-877-418-05062026 Medicare rate for CPT 64493
Office (non-facility)
$190.39
Facility
$81.50
Total RVUs (office)
5.70
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 64493 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes documenting axial pain pattern without radiculopathy, Conservative treatment documentation (4-6 weeks), Prior diagnostic block results with pain relief percentage (for therapeutic requests)….
- 3Submit via phone or fax, or the payer portal.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 64493?
- Yes. Humana requires prior authorization for CPT 64493 (Site of service - Muscular/skeletal procedures (outpatient hospital/ASC only)) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 64493?
- Clinical notes documenting axial pain pattern without radiculopathy; Conservative treatment documentation (4-6 weeks); Prior diagnostic block results with pain relief percentage (for therapeutic requests); Imaging guidance confirmation (fluoroscopy)
- How much does Medicare pay for CPT 64493 in 2026?
- In 2026, the national Medicare allowable for CPT 64493 is $190.39 in an office setting and $81.50 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 64493?
- 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 Humana PA lookups
CPT 64493 prior authorization by payer
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