95783 prior authorization | Premera Blue Cross of Washington

95783, Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by technologist, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 95783
Description: Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by technologist
Source: Clinical Review by Code List PBCWA, Pg 521 Original policy

Premera Blue Cross of Washington prior authorization

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