Anthem Blue Cross and Blue Shield New Hampshire prior authorization 64495

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for 64495: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

Code: 64495
Description: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 136 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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