55874 prior authorization | Blue Cross and Blue Shield of Montana

55874, Transperineal Placement Of Biodegradable Material Peri-Prostatic Single Or Multiple Injection(S) Including Image Guidance When Performed, is on the Blue Cross and Blue Shield of Montana commercial 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: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 47 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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