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Blue Shield of California Promise Health Plan prior authorization 0889T

Blue Shield of California Promise Health Plan prior authorization for 0889T: Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation derived from a structural and resting-state functional MRI, including data preparation and transmission, generation of the target, motor threshold-starting location, neuronavigation files and target report, review and interpretation

Code
0889T
Description
Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation derived from a structural and resting-state functional MRI, including data preparation and transmission, generation of the target, motor threshold-starting location, neuronavigation files and target report, review and interpretation
Source
Medi-Cal Prior Authorization List, Pg 18 Original policy

Blue Shield of California Promise Health Plan prior authorization

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