C5273 prior authorization | Anthem Blue Cross and Blue Shield Nevada

C5273, Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of b, is on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage or referral decision.

Code: C5273
Description: Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of b
Source: Nevada Prior Authorization List, Pg 138 Original policy

Anthem Blue Cross and Blue Shield Nevada prior authorization

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