55874 prior authorization | Premera Blue Cross of Washington

55874, Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, 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: 55874
Description: Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 353 Original policy

Premera Blue Cross of Washington prior authorization

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