43644 prior authorization | Anthem Blue Cross and Blue Shield Virginia

43644, Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroenterostomy (Roux Limb <= 150 Cm), is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 43644
Description: Laparoscopy, Surg, Gastric Restrictive Procedure; W Gastric Bypass And Roux-En-Y Gastroenterostomy (Roux Limb <= 150 Cm)
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 21 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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