0634T prior authorization | Premera Blue Cross of Washington

0634T, Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0634T
Description: Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 136 Original policy

Premera Blue Cross of Washington prior authorization

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