64484 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

64484, Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (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: 64484
Description: Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 136 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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