B4199 prior authorization | Blue Cross and Blue Shield of Montana

B4199, Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 100 Grams Of Protein - Premix, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: B4199
Description: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength Over 100 Grams Of Protein - Premix
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 251 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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