0964T prior authorization | Anthem Blue Cross Blue Shield of Colorado

0964T, Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; single arch, without mandibular advancement mecha, is on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage or referral decision.

Code: 0964T
Description: Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; single arch, without mandibular advancement mecha
Source: Colorado Prior Authorization List, Pg 141 Original policy

Anthem Blue Cross Blue Shield of Colorado prior authorization

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