64490 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
64490, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.
- Code
- 64490
- Description
- Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
- Source
- New Hampshire Precertification List, Pg 136 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization