C5274 prior authorization | Anthem Blue Cross Blue Shield of Colorado

C5274, Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, is on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage or referral decision.

Code: C5274
Description: Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area
Source: Colorado Prior Authorization List, Pg 146 Original policy

Anthem Blue Cross Blue Shield of Colorado prior authorization

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