Prior Authorization Required List ANESTH EAR EXAM. N. 00126. ANESTH ... N. 15860. Test for blood flow in graft. N. 15876 ... N. 99479. Ic lbw inf 1500-2500 g subsq. N. 99480.
CXT 2Q - Horizon Blue Cross Blue Shield 96116 NEUROBEHAVIORAL STATUS EXAM. G9481 REMOTE E/M NEW PT 10MI ... 99479 IC LBW INF 1500-2500 G SUBSQ. 5/1/2016. N. X. X. X. 124472. ME.
Control Log No. S261 Page 1 of 11 - dhcf Parasymp&symp hrt rate test. 99190. Special pump services. 99191. Special pump ... Ic lbw inf 1500-2500 g subsq. 99480. Ic inf pbw 2501-5000 g subsq. 99485.