J1572 prior authorization | Anthem Blue Cross Blue Shield of Georgia

J1572, Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: J1572
Description: Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg
Source: Standard Local Prior Authorization Code List, Pg 147 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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