Prior Auth Required

61791 - Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract

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Procedure / ServiceCreation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract
Procedure / Service Description

magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or - 61737 complex lesion(s) 61790 Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Gasserian Ganglion 61791 Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract Stereotactic radiosurgery (particle beam, gamma ray, or linear accelerator); 1 simple cranial 61796 lesion

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
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  • Use the insurer authorization workflow for this listed code.