43257 prior authorization | Premera Blue Cross of Washington

43257, Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 43257
Description: Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease
Source: Clinical Review by Code List PBCWA, Pg 338 Original policy

Premera Blue Cross of Washington prior authorization

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