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58999 prior authorization | Anthem Blue Cross Blue Shield of California

58999, Unlisted procedure, female genital system (nonobstetrical) [when specified as any vaginal rejuvenation or tightening procedure for atrophy, including laser procedures such as MonaLisa Touch] or [when specified as cancer screening or identification using an optical detection system] or [when specified as image-guided percutaneous ablation by laser, bipolar electrodes, interstitial thermotherapy, cryotherapy, radiofrequency], is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code
58999
Description
Unlisted procedure, female genital system (nonobstetrical) [when specified as any vaginal rejuvenation or tightening procedure for atrophy, including laser procedures such as MonaLisa Touch] or [when specified as cancer screening or identification using an optical detection system] or [when specified as image-guided percutaneous ablation by laser, bipolar electrodes, interstitial thermotherapy, cryotherapy, radiofrequency]
Source
California PPO Prior Authorization List, Pg 10 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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