0201T prior authorization | Premera Blue Cross of Washington

0201T, Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0201T
Description: Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles
Source: Clinical Review by Code List PBCWA, Pg 41 Original policy

Premera Blue Cross of Washington prior authorization

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