G2083 prior authorization | Premera Blue Cross of Washington

G2083, Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: G2083
Description: Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self administration, includes 2 hours post administration observation
Source: Clinical Review by Code List PBCWA, Pg 689 Original policy

Premera Blue Cross of Washington prior authorization

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