Premera Blue Cross · PayerPolicy · PREMERA-9-02-502-PERIODONTICS-0ACF98C5AF
Summary of the payer’s published policy. Not a coverage determination — confirm with Premera Blue Cross before submitting.
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Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
Backwork has no codes on record for this policy. Check the source.