Cigna prior authorization for 55882*: Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed
Code
55882*
Description
Ablation of prostate tissue, transurethral, using thermal ultrasound,
including magnetic resonance imaging guidance for, and monitoring of,
tissue ablation; with insertion of transurethral ultrasound transducer for
delivery of thermal ultrasound, including suprapubic tube placement and
placement of an endorectal cooling device, when performed
Source
Master Precertification List
For Health Care Providers, Pg 47 Original policy
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