58573 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

58573, Laparoscopy; surgical, with total hysterectomy, for uterus greater than 250 g, with removal of tube(s) and/or ovary (s), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 58573
Description: Laparoscopy; surgical, with total hysterectomy, for uterus greater than 250 g, with removal of tube(s) and/or ovary (s)
Source: New Hampshire Precertification List, Pg 125 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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