78452 prior authorization | Blue Cross Blue Shield Oklahoma
78452, Myocardial Perfusion Imaging Tomographic (Spect) (Including Attenuation Correction Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Multiple Studies At Rest And/Or Stress (Exercise Or Pharmacologic) And/Or Redistribution And/Or Rest Reinjection, is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.
- Code
- 78452
- Description
- Myocardial Perfusion Imaging Tomographic (Spect) (Including Attenuation Correction Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Multiple Studies At Rest And/Or Stress (Exercise Or Pharmacologic) And/Or Redistribution And/Or Rest Reinjection
- Source
- 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 29 Original policy