53899 prior authorization | Anthem Blue Cross Blue Shield of California

53899, Unlisted procedure, urinary system [when specified as transurethral MRI directional ultrasound ablation of prostate tissue (TULSA)] or [when specified as use of a portable normothermic organ perfusion system for kidney transplantation], is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 53899
Description: Unlisted procedure, urinary system [when specified as transurethral MRI directional ultrasound ablation of prostate tissue (TULSA)] or [when specified as use of a portable normothermic organ perfusion system for kidney transplantation]
Source: California PPO Prior Authorization List, Pg 9 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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