Q5105 prior authorization | Anthem Blue Cross and Blue Shield Virginia

Q5105, Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: Q5105
Description: Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 units
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 79 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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