Premera Blue Cross of Washington prior authorization 0179U

Premera Blue Cross of Washington prior authorization for 0179U: Oncology (non-small cell lung cancer), cell- free DNA, targeted sequence analysis of 23 genes (single nucleotide variations, insertions and deletions, fusions without prior knowledge of partner/breakpoint, copy number variations), with report of significant mutation(s) These criteria do not imply or guarantee approval.

Code: 0179U
Description: Oncology (non-small cell lung cancer), cell- free DNA, targeted sequence analysis of 23 genes (single nucleotide variations, insertions and deletions, fusions without prior knowledge of partner/breakpoint, copy number variations), with report of significant mutation(s) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 37 Original policy

Premera Blue Cross of Washington prior authorization

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