B4197 prior authorization | Blue Cross Blue Shield Oklahoma

B4197, Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 74 To 100 Grams Of Protein - Premix, is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.

Code: B4197
Description: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 74 To 100 Grams Of Protein - Premix
Source: 2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 201 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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