64583 prior authorization | Premera Blue Cross of Washington

64583, Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 64583
Description: Revision or replacement of hypoglossal nerve neurostimulator array and distal respiratory sensor electrode or electrode array, including connection to existing pulse generator
Source: Clinical Review by Code List PBCWA, Pg 378 Original policy

Premera Blue Cross of Washington prior authorization

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