Q4074 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

Q4074, Iloprost, inhalation solution, FDA- approved final product, noncompounded, administered through DME, unit dose form, up to 20 mcg, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: Q4074
Description: Iloprost, inhalation solution, FDA- approved final product, noncompounded, administered through DME, unit dose form, up to 20 mcg
Source: New Hampshire Precertification List, Pg 254 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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