64590 prior authorization | Blue Cross and Blue Shield of Montana

64590, Insertion Or Replacement Of Peripheral Sacral Or Gastric Neurostimulator Pulse Generator Or Receiver Requiring Pocket Creation And Connection Between Electrode Array And Pulse Generator Or Receiver, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 64590
Description: Insertion Or Replacement Of Peripheral Sacral Or Gastric Neurostimulator Pulse Generator Or Receiver Requiring Pocket Creation And Connection Between Electrode Array And Pulse Generator Or Receiver
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 68 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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