58545 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

58545, Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 58545
Description: Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas
Source: New Hampshire Precertification List, Pg 10 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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