Anthem Blue Cross Blue Shield of California prior authorization 0620T

Anthem Blue Cross Blue Shield of California prior authorization for 0620T: Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural road mapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed

Code

0620T

Description

Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural road mapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed

Source

California PPO Prior Authorization List, Pg 54 Original policy

Anthem Blue Cross Blue Shield of California prior authorization