Blue Cross and Blue Shield of Montana prior authorization L5858

Blue Cross and Blue Shield of Montana prior authorization for L5858: Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Code: L5858
Description: Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 274 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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