15771 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

15771, Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 15771
Description: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate
Source: New Hampshire Precertification List, Pg 80 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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