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Anthem Blue Cross Blue Shield of California prior authorization 1107T

Anthem Blue Cross Blue Shield of California prior authorization for 1107T: Oncology (prostate), augmentative algorithmic analysis of histomorphologic features in digitized hematoxylin and eosin stained slide(s) from formalin-fixed paraffin-embedded (FFPE) prostate cancer tissue, algorithm-derived parameters reported as 10-year risk of distant metastasis and prostate cancer specific mortality, including hematoxylin and eosin staining of tissue sections, and digitization of glass microscope slides, when performed [ArteraAI Prostate test algorithm]

Code
1107T
Description
Oncology (prostate), augmentative algorithmic analysis of histomorphologic features in digitized hematoxylin and eosin stained slide(s) from formalin-fixed paraffin-embedded (FFPE) prostate cancer tissue, algorithm-derived parameters reported as 10-year risk of distant metastasis and prostate cancer specific mortality, including hematoxylin and eosin staining of tissue sections, and digitization of glass microscope slides, when performed [ArteraAI Prostate test algorithm]
Source
California PPO Prior Authorization List, Pg 19 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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