G0460 prior authorization | Anthem Blue Cross and Blue Shield Virginia

G0460, Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all ot, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: G0460
Description: Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all ot
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 66 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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