G0330 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

G0330, Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: G0330
Description: Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
Source: New Hampshire Precertification List, Pg 229 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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