G0465 prior authorization | Anthem Blue Cross and Blue Shield Virginia
G0465, Autologous platelet rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes as applicab, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.
- Code
- G0465
- Description
- Autologous platelet rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes as applicab
- Source
- Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 66 Original policy
Anthem Blue Cross and Blue Shield Virginia prior authorization