Premera Blue Cross of Washington prior authorization 0497U

Premera Blue Cross of Washington prior authorization for 0497U: Oncology (prostate), mRNA gene- expression profiling by real-time RT-PCR of 6 genes (FOXM1, MCM3, MTUS1, TTC21B, ALAS1, and PPP2CA), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a risk score for prostate cancer

Code: 0497U
Description: Oncology (prostate), mRNA gene- expression profiling by real-time RT-PCR of 6 genes (FOXM1, MCM3, MTUS1, TTC21B, ALAS1, and PPP2CA), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a risk score for prostate cancer
Source: Clinical Review by Code List PBCWA, Pg 100 Original policy

Premera Blue Cross of Washington prior authorization

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