Anthem Blue Cross and Blue Shield New Hampshire prior authorization 0628T

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 0628T: Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)

Code: 0628T
Description: Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 65 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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