58263 prior authorization | Premera Blue Cross of Washington

58263, Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele 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: 58263
Description: Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 357 Original policy

Premera Blue Cross of Washington prior authorization

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