19380 prior authorization | Premera Blue Cross of Washington
19380, Revision of reconstructed breast (eg, significant removal of tissue, re- advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 19380
- Description
- Revision of reconstructed breast (eg, significant removal of tissue, re- advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)
- Source
- Clinical Review by Code List PBCWA, Pg 242 Original policy