J1557 prior authorization | Anthem Blue Cross and Blue Shield Virginia

J1557, Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: J1557
Description: Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 68 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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