23474 prior authorization | Premera Blue Cross of Washington

23474, Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component 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: 23474
Description: Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 264 Original policy

Premera Blue Cross of Washington prior authorization

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