58267 prior authorization | Premera Blue Cross of Washington

58267, Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall- Marchetti-Krantz type, Pereyra type) with or without endoscopic control, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 58267
Description: Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall- Marchetti-Krantz type, Pereyra type) with or without endoscopic control
Source: Clinical Review by Code List PBCWA, Pg 358 Original policy

Premera Blue Cross of Washington prior authorization

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