Anthem Blue Cross Blue Shield of California prior authorization Q4133

Anthem Blue Cross Blue Shield of California prior authorization for Q4133: Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per square centimeter [when specified as Grafix PRIME, for diabetic foot ulcers only] or [when specified as GrafixPL PRIME, Stravix, StravixPL]

Code: Q4133
Description: Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per square centimeter [when specified as Grafix PRIME, for diabetic foot ulcers only] or [when specified as GrafixPL PRIME, Stravix, StravixPL]
Source: California PPO Prior Authorization List, Pg 171 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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