Premera Blue Cross of Washington prior authorization 63057

Premera Blue Cross of Washington prior authorization for 63057: Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)

Code: 63057
Description: Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)
Source: Clinical Review by Code List PBCWA, Pg 373 Original policy

Premera Blue Cross of Washington prior authorization

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