A4100 prior authorization | Anthem Blue Cross and Blue Shield Virginia

A4100, Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure), is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: A4100
Description: Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure)
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 61 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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