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Premera Blue Cross of Washington prior authorization 0440U

Premera Blue Cross of Washington prior authorization for 0440U: Cardiology (coronary heart disease) DNA analysis of 10 single-nucleotide polymorphisms (rs710987[LINC010019],rs1333048[CDKN2 B-AS1],rs12129789 [KCND3],rs942317 [KTN1-AS1],rs1441433 [PPP3CA],rs2869675 [PREX1],rs4639796 [ZBTB41],rs4376434 [LINC00972],rs12714414 [TMEM18],rs7585056 [TMEM18]) & 6 DNA methylation markers (cg03725309 [SARS1],cg12586707 [CXCL1,cg04988978 [MPO],cg17901584 [DHCR24- DT],cg21161138 [AHRR],cg12655112 [EHD4]),qPCR, digital PCR, whole blood, algorithm reported as detected or not

Code
0440U
Description
Cardiology (coronary heart disease) DNA analysis of 10 single-nucleotide polymorphisms (rs710987[LINC010019],rs1333048[CDKN2 B-AS1],rs12129789 [KCND3],rs942317 [KTN1-AS1],rs1441433 [PPP3CA],rs2869675 [PREX1],rs4639796 [ZBTB41],rs4376434 [LINC00972],rs12714414 [TMEM18],rs7585056 [TMEM18]) & 6 DNA methylation markers (cg03725309 [SARS1],cg12586707 [CXCL1,cg04988978 [MPO],cg17901584 [DHCR24- DT],cg21161138 [AHRR],cg12655112 [EHD4]),qPCR, digital PCR, whole blood, algorithm reported as detected or not
Source
Clinical Review by Code List PBCWA, Pg 86 Original policy

Premera Blue Cross of Washington prior authorization

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