Premera Blue Cross of Washington prior authorization 63030

Premera Blue Cross of Washington prior authorization for 63030: Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar These criteria do not imply or guarantee approval.

Code: 63030
Description: Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 368 Original policy

Premera Blue Cross of Washington prior authorization

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