64590 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

64590, Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 64590
Description: Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver
Source: New Hampshire Precertification List, Pg 137 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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