43210 prior authorization | Premera Blue Cross of Washington

43210, Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy 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: 43210
Description: Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 336 Original policy

Premera Blue Cross of Washington prior authorization

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