Blue Cross and Blue Shield of Montana prior authorization B4152
Blue Cross and Blue Shield of Montana prior authorization for B4152: Enteral Formula Nutritionally Complete Calorically Dense (Equal To Or Greater Than 1. 5 Kcal/Ml) With Intact Nutrients Includes Proteins Fats Carbohydrates Vitamins And Minerals May Include Fiber Administered Through An Enteral Feeding Tube 100 Calories = 1 Unit
- Code
- B4152
- Description
- Enteral Formula Nutritionally Complete Calorically Dense (Equal To Or Greater Than 1. 5 Kcal/Ml) With Intact Nutrients Includes Proteins Fats Carbohydrates Vitamins And Minerals May Include Fiber Administered Through An Enteral Feeding Tube 100 Calories = 1 Unit
- Source
- 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 248 Original policy