0628T prior authorization | Anthem Blue Cross Blue Shield of California

0628T, Percutaneous injection of allogeneic cellular and/or tissue- based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 0628T
Description: Percutaneous injection of allogeneic cellular and/or tissue- based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level
Source: California PPO Prior Authorization List, Pg 143 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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