Blue Cross and Blue Shield of Montana prior authorization B4189

Blue Cross and Blue Shield of Montana prior authorization for B4189: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 10 To 51 Grams Of Protein - Premix

Code: B4189
Description: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 10 To 51 Grams Of Protein - Premix
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 251 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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