Premera Blue Cross of Washington prior authorization L5858

Premera Blue Cross of Washington prior authorization for L5858: Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type These criteria do not imply or guarantee approval.

Code: L5858
Description: Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 761 Original policy

Premera Blue Cross of Washington prior authorization

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