Medicaid Prior Authorization Required for CPT Code 64484, effective 2/1/2026

Date: 12/19/25

Medicaid Prior Authorization Required for CPT Code 64484

Effective February 1, 2026

Arizona Complete Health-Complete Care Plan will require prior authorization (PA) for CPT code 64484 for date of services February 1, 2026, and after.

Code	Description	PA Rule
64484	Injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection in the lumbar or sacral region	PA required for all providers

Important Reminders

•  Use the Pre-Auth Check Tool at www.arizonacompletehealth.com -> For Providers -> Pre-Auth Check to confirm if a CPT/HCPCS code requires PA
• Non-par providers and facilities must obtain PA for ALL SERVICES unless the Pre Auth Check Tool states otherwise
• Verify eligibility and benefits before providing services. PA approval does not guarantee payment
• The Pre-Auth Check Tool reflects PA requirements as of the time of your search. It does not show future updates or changes.

Questions? Please contact your Provider Engagement Account Manager or email us at AzCHProviderEngagement@azcompletehealth.com