64630 CPT® code: payer coverage and prior authorization64630 appears in 11 coverage policies from Aetna, Blue Cross NC.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered (range 64600-64647) | Jun 19, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Laser Neurolysis (0552) | listed, no stance (range 64620-64640) | Aug 3, 2026 | payer document |
| Aetna | Levator Syndrome Treatments (0679) | not covered | Oct 15, 2025 | payer document |
| Aetna | Post-Herpetic Neuralgia (0725) | not covered (range 64600-64640) | Oct 20, 2025 | payer document |
| Aetna | Pudendal Nerve Decompression (0805) | not covered | Nov 20, 2025 | payer document |
| Aetna | Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) | listed, no stance (range 61000-64999) | Jul 9, 2026 | payer document |
| Aetna | Spasticity Management (0362) | covered if criteria are met (range 64600-64640) | May 26, 2026 | payer document |
| Aetna | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| Aetna | Vulvodynia and Vulvar Vestibulitis Treatments (0759) | not covered | Nov 12, 2025 | payer document |
| Blue Cross NC | Ablation and Neural Therapy Procedures for Headache and Pain Management | listed, no stance | Feb 1, 2026 | payer document |
Prior authorization required or conditional in WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.