Blue Cross and Blue Shield of Montana prior authorization 0576U

Blue Cross and Blue Shield of Montana prior authorization for 0576U: Transplantation medicine (liver allograft rejection), quantitative donor-derived cell- free DNA (cfDNA) by whole genome nextgeneration sequencing, plasma and mRNA gene expression profiling by multiplex real-time PCR of 56 genes, whole blood, combined algorithm reported as a rejection risk score

Code: 0576U
Description: Transplantation medicine (liver allograft rejection), quantitative donor-derived cell- free DNA (cfDNA) by whole genome nextgeneration sequencing, plasma and mRNA gene expression profiling by multiplex real-time PCR of 56 genes, whole blood, combined algorithm reported as a rejection risk score
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 237 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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