C5272 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

C5272, Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: C5272
Description: Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)
Source: New Hampshire Precertification List, Pg 213 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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