0784T prior authorization | Premera Blue Cross of Washington

0784T, Insertion or replacement of percutaneous electrode array, spinal. with integrated neurostimulator, including imaging guidance. when performed 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: 0784T
Description: Insertion or replacement of percutaneous electrode array, spinal. with integrated neurostimulator, including imaging guidance. when performed These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 167 Original policy

Premera Blue Cross of Washington prior authorization

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