Anthem Blue Cross Blue Shield of Georgia prior authorization B4197

Anthem Blue Cross Blue Shield of Georgia prior authorization for B4197: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix

Code: B4197
Description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix
Source: Standard Local Prior Authorization Code List, Pg 143 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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