63664 prior authorization | Premera Blue Cross of Washington

63664, Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 63664
Description: Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
Source: Clinical Review by Code List PBCWA, Pg 377 Original policy

Premera Blue Cross of Washington prior authorization

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