Premera Blue Cross of Washington prior authorization 0784T

Premera Blue Cross of Washington prior authorization for 0784T: Insertion or replacement of percutaneous electrode array, spinal. with integrated neurostimulator, including imaging guidance. when performed These criteria do not imply or guarantee approval.

Code: 0784T
Description: Insertion or replacement of percutaneous electrode array, spinal. with integrated neurostimulator, including imaging guidance. when performed These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 167 Original policy

Premera Blue Cross of Washington prior authorization

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