63621 prior authorization | Premera Blue Cross of Washington

63621, Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 63621
Description: Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); each additional spinal lesion (List separately in addition to code for primary procedure)
Source: Clinical Review by Code List PBCWA, Pg 376 Original policy

Premera Blue Cross of Washington prior authorization

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