72133 prior authorization | Premera Blue Cross of Washington

72133, Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections 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: 72133
Description: Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 398 Original policy

Premera Blue Cross of Washington prior authorization

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