Q4116 prior authorization | Anthem Blue Cross Blue Shield of California

Q4116, AlloDerm, per square centimeter [AlloDerm RTM, AlloDerm RTU for breast reconstruction and abdominal wall wounds], is on the Anthem Blue Cross Blue Shield of California PPO prior authorization list. Not a coverage or referral decision.

Code: Q4116
Description: AlloDerm, per square centimeter [AlloDerm RTM, AlloDerm RTU for breast reconstruction and abdominal wall wounds]
Source: California PPO Prior Authorization List, Pg 170 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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