Prior Auth Required

0200T - Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or

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Procedure / ServicePercutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or
Procedure / Service Description

Code NAME/DESCRIPTION COMMENTS - 0072T Focused ultrasound ablation of uterine leiomyomata, including MR guidance; total leiomyomata volume greater or equal to 200 cc of tissue 0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed

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  • Submit clinical notes if requested by the plan
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