78433 prior authorization | Blue Cross Blue Shield Oklahoma
78433, Myocardial Imaging Positron Emission Tomography (Pet) Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed) Dual Radiotracer (Eg Myocardial Viability); With Concurrently Acquired Computed Tomography Transmission Scan, is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.
- Code
- 78433
- Description
- Myocardial Imaging Positron Emission Tomography (Pet) Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed) Dual Radiotracer (Eg Myocardial Viability); With Concurrently Acquired Computed Tomography Transmission Scan
- Source
- 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 28 Original policy