S0196 prior authorization | Anthem Blue Cross Blue Shield of Colorado

S0196: Injectable poly-l-lactic acid, restorative implant, 1 ml, face (deep dermis, subcutaneous layers). 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: S0196
Description: Injectable poly-l-lactic acid, restorative implant, 1 ml, face (deep dermis, subcutaneous layers)
Source: Colorado Prior Authorization List, Pg 175 Original policy

Anthem Blue Cross Blue Shield of Colorado prior authorization

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