C9774 prior authorization | Anthem Blue Cross and Blue Shield Virginia

C9774, Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: C9774
Description: Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 63 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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