55874 prior authorization | Anthem Blue Cross Blue Shield of California

55874, Transperineal placement of biodegradable material, peri- prostatic, single or multiple injection(s), including image guidance, when performed, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: 55874
Description: Transperineal placement of biodegradable material, peri- prostatic, single or multiple injection(s), including image guidance, when performed
Source: California PPO Prior Authorization List, Pg 104 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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