Passport by Molina Healthcare policy
Breyanzi
Breyanzi is a public Passport by Molina Healthcare policy (effective Dec 15, 2025). It lists 9 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Effective
- Dec 15, 2025
- Line of business
- Medicaid
- States
- KY
- Source
- www.molinahealthcare.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Passport by Molina Healthcare policies |
|---|---|
| 0537T | Policies naming 0537T |
| 0538T | Policies naming 0538T |
| 0539T | Policies naming 0539T |
| 0540T | Policies naming 0540T |
| 38225 | Policies naming 38225 |
| 38226 | Policies naming 38226 |
| 38227 | Policies naming 38227 |
| 38228 | Policies naming 38228 |
| Q2054 | Policies naming Q2054 |