Anthem Blue Cross Blue Shield of Colorado prior authorization Q4105
Anthem Blue Cross Blue Shield of Colorado 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
- Colorado Prior Authorization List, Pg 166 Original policy
Anthem Blue Cross Blue Shield of Colorado prior authorization