Blue Shield of California Promise Health Plan prior authorization 76014

Blue Shield of California Promise Health Plan prior authorization for 76014: MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging), analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; initial 15 minutes

Code

76014

Description

MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging), analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; initial 15 minutes

Source

Medi-Cal Prior Authorization List, Pg 5 Original policy

Blue Shield of California Promise Health Plan prior authorization