E0491 prior authorization | Anthem Blue Cross Blue Shield of California

E0491, Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: E0491
Description: Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardware remote, 90-day supply
Source: California PPO Prior Authorization List, Pg 162 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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