19368 prior authorization | Anthem Blue Cross and Blue Shield Virginia
19368, Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging), is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.
- Code
- 19368
- Description
- Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging)
- Source
- Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 12 Original policy
Anthem Blue Cross and Blue Shield Virginia prior authorization