Blue Shield of California Promise Health Plan prior authorization G0683

Blue Shield of California Promise Health Plan prior authorization for G0683: Application of a premarket approval (PMA), 510(k), 361 human cells, tissues or cellular and tissue-based products (HCT/P) nonsheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Code: G0683
Description: Application of a premarket approval (PMA), 510(k), 361 human cells, tissues or cellular and tissue-based products (HCT/P) nonsheet form skin substitute graft for a wound surface greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children
Source: Medi-Cal Prior Authorization List, Pg 26 Original policy

Blue Shield of California Promise Health Plan prior authorization

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