Anthem Blue Cross and Blue Shield New Hampshire prior authorization 61791

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 61791: Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Code: 61791
Description: Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract
Source: New Hampshire Precertification List, Pg 126 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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