64597 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

64597, Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (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: 64597
Description: Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 11 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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