K0189
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Key Coverage Criteria
- Pulmonary hypertension;or
- Documented ischemic heart disease;or
- Impaired cognition or mood disorders;or
- History of stroke;or
- Hypertension;or
- Ischemic heart disease or history of stroke;or
2 Active Policies
ANTHEM-SURG.00129 — SURG.00129 Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring
ANTHEM-MED.00002 — MED.00002 Selected Sleep Testing Services
Related Codes
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