K0877 prior authorization | Anthem Blue Cross and Blue Shield Virginia

K0877, POWER WHEELCHAIR, GROUP 4 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUD, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: K0877
Description: POWER WHEELCHAIR, GROUP 4 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUD
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 74 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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