0686T prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

0686T, Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 0686T
Description: Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance
Source: New Hampshire Precertification List, Pg 68 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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