Anthem Blue Cross Blue Shield of California prior authorization S2067

Anthem Blue Cross Blue Shield of California prior authorization for S2067: Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral

Code: S2067
Description: Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral
Source: California PPO Prior Authorization List, Pg 30 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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