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Q4174 prior authorization | Anthem Blue Cross Blue Shield of Colorado

Q4174: Palingen or promatrx, 0.36 mg per 0.25 cc. Imported Anthem Blue Cross Blue Shield of Colorado source reference; confirm plan-specific review requirements in the original document. Not a coverage or referral decision.

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Code
Q4174
Description
Palingen or promatrx, 0.36 mg per 0.25 cc
Source
Colorado Prior Authorization List, Pg 168 Original policy

Anthem Blue Cross Blue Shield of Colorado prior authorization

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