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Medicaid Prior Auth Changes Effective 11/15/2025

Date: 10/15/25

Medicaid Prior Authorization Required for CPT Code 64491

Effective November 15, 2025

For dates of service November 15, 2025 and after, Arizona Complete Health-Complete Care Plan will require prior authorization (PA) for  CPT code 64491.

Service Category

Service

Procedure Code

PA Rule

Pain Management

Paravertebral Facet Joint Injection

64491

PA required for All providers

Important Reminders

  • 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
  • Use the Pre-Auth Check Tool at www.arizonacompletehealth.com -> For Providers -> Pre-Auth Check to confirm if a CPT/HCPCS code requires PA
  • 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:📧AzCHProviderEngagement@azcompletehealth.com