G0330 prior authorization | Premera Blue Cross of Washington

G0330, Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: G0330
Description: Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room
Source: Clinical Review by Code List PBCWA, Pg 685 Original policy

Premera Blue Cross of Washington prior authorization

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