58954 prior authorization | Anthem Blue Cross and Blue Shield Virginia

58954, Bilat Salping-Oophorec W/Omentec, Tl Abd Hyst & Radcl Dissec, Debul; W/Pelv & Ltd Paraaortic Lymp, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 58954
Description: Bilat Salping-Oophorec W/Omentec, Tl Abd Hyst & Radcl Dissec, Debul; W/Pelv & Ltd Paraaortic Lymp
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 23 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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