G0330 prior authorization | Anthem Blue Cross Blue Shield of California

G0330, Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: G0330
Description: Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
Source: California PPO Prior Authorization List, Pg 162 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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