Anthem Blue Cross and Blue Shield Nevada prior authorization Q4105

Anthem Blue Cross and Blue Shield Nevada prior authorization for Q4105: Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)

Code: Q4105
Description: Integra dermal regeneration template (drt) or integra omnigraft dermal regeneration matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Source: Nevada Prior Authorization List, Pg 159 Original policy

Anthem Blue Cross and Blue Shield Nevada prior authorization

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