Anthem Blue Cross and Blue Shield New Hampshire prior authorization Q2055

Anthem Blue Cross and Blue Shield New Hampshire prior authorization for Q2055: Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose

Code: Q2055
Description: Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Source: New Hampshire Precertification List, Pg 254 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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