Blue Cross Blue Shield Oklahoma prior authorization B4193

Blue Cross Blue Shield Oklahoma prior authorization for B4193: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 52 To 73 Grams Of Protein - Premix

Code: B4193
Description: Parenteral Nutrition Solution; Compounded Amino Acid And Carbohydrates With Electrolytes Trace Elements And Vitamins Including Preparation Any Strength 52 To 73 Grams Of Protein - Premix
Source: 2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 201 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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