B4197 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

B4197, Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: B4197
Description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 g of protein - premix
Source: New Hampshire Precertification List, Pg 209 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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