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[DOI] [PubMed] [Google Scholar] 69.Gussak I., Brugada P., Brugada J., Wright R.S., Kopecky S.L., Chaitman B.R., Bjerregaard P

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The pre-authorization request should include the diagnosis code(s), clinical rationale for the imaging guidance, and documentation of any prior conservative treatment trials (physical therapy, oral medications) that failed to provide relief