Blue Cross and Blue Shield of Montana prior authorization B4154
Blue Cross and Blue Shield of Montana prior authorization for B4154: Enteral Formula Nutritionally Complete For Special Metabolic Needs Excludes Inherited Disease Of Metabolism Includes Altered Composition Of Proteins Fats Carbohydrates Vitamins And/Or Minerals May Include Fiber Administered Through An Enteral Feeding Tube 100 Calories = 1 Unit
- Code
- B4154
- Description
- Enteral Formula Nutritionally Complete For Special Metabolic Needs Excludes Inherited Disease Of Metabolism Includes Altered Composition Of Proteins Fats Carbohydrates Vitamins And/Or 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