J2787 prior authorization | Anthem Blue Cross and Blue Shield Virginia

J2787, Riboflavin 5'-phosphate, ophthalmic solution (photrexa viscous/photrexa), up to 3 ml, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: J2787
Description: Riboflavin 5'-phosphate, ophthalmic solution (photrexa viscous/photrexa), up to 3 ml
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 69 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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