Anthem Blue Cross and Blue Shield New Hampshire prior authorization 61790

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 61790: Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion

Code: 61790
Description: Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion
Source: New Hampshire Precertification List, Pg 126 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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