Q4122 prior authorization | Blue Cross Blue Shield Oklahoma

Q4122, Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure), is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.

Code: Q4122
Description: Dermacell, dermacell awm or dermacell awm porous, per square centimeter (add-on, list separately in addition to primary procedure)
Source: 2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 254 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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