0965T prior authorization | Premera Blue Cross of Washington

0965T, Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, non-fixed hinge mechanism, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0965T
Description: Impression and custom preparation of jaw expansion oral prosthesis for obstructive sleep apnea, including initial adjustment; dual arch, with additional mandibular advancement, non-fixed hinge mechanism
Source: Clinical Review by Code List PBCWA, Pg 200 Original policy

Premera Blue Cross of Washington prior authorization

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