Premera Blue Cross of Washington prior authorization 0576U

Premera Blue Cross of Washington prior authorization for 0576U: Transplantation medicine (liver allograft rejection), quantitative donor-derived cell- free DNA (cfDNA) by whole genome next- generation 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 next- generation 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: Clinical Review by Code List PBCWA, Pg 119 Original policy

Premera Blue Cross of Washington prior authorization

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