G0681 prior authorization | Anthem Blue Cross Blue Shield of California
G0681, Application of a premarket approval (PMA), 510(k), 361 human cells, tissues or cellular and tissue-based products (HCT/P) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area, is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.
- Code
- G0681
- Description
- Application of a premarket approval (PMA), 510(k), 361 human cells, tissues or cellular and tissue-based products (HCT/P) non-sheet form skin substitute for a wound surface area up to 100 sq cm; first 25 sq cm or less of wound surface area
- Source
- California PPO Prior Authorization List, Pg 25 Original policy
Anthem Blue Cross Blue Shield of California prior authorization