B4199 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
B4199, Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 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
- B4199
- Description
- Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 g of protein - premix
- Source
- New Hampshire Precertification List, Pg 210 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization