61642 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

61642, Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (List separately in addition to code for primary procedure), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 61642
Description: Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 10 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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