A2004 prior authorization | Anthem Blue Cross Blue Shield of Colorado
A2004, Xcellistem, 1 mg/Original description: Miscellaneous with Motor <27.85, without comorbidities,10/2019 description: Miscellaneous M <46.50 and A >=77.50.,witho, is on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage or referral decision.
- Code
- A2004
- Description
- Xcellistem, 1 mg/Original description: Miscellaneous with Motor <27.85, without comorbidities,10/2019 description: Miscellaneous M <46.50 and A >=77.50.,witho
- Source
- Colorado Prior Authorization List, Pg 142 Original policy
Anthem Blue Cross Blue Shield of Colorado prior authorization