Blue Cross and Blue Shield of Montana prior authorization 64590

Blue Cross and Blue Shield of Montana prior authorization for 64590: Insertion Or Replacement Of Peripheral Sacral Or Gastric Neurostimulator Pulse Generator Or Receiver Requiring Pocket Creation And Connection Between Electrode Array And Pulse Generator Or Receiver

Code: 64590
Description: Insertion Or Replacement Of Peripheral Sacral Or Gastric Neurostimulator Pulse Generator Or Receiver Requiring Pocket Creation And Connection Between Electrode Array And Pulse Generator Or Receiver
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 68 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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