58152 prior authorization | Premera Blue Cross of Washington

58152, Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall- Marchetti-Krantz, Burch), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 58152
Description: Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall- Marchetti-Krantz, Burch)
Source: Clinical Review by Code List PBCWA, Pg 357 Original policy

Premera Blue Cross of Washington prior authorization

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