Premera Blue Cross of Washington prior authorization 81403

Premera Blue Cross of Washington prior authorization for 81403: Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) These criteria do not imply or guarantee approval.

Code: 81403
Description: Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2-5 exons) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 479 Original policy

Premera Blue Cross of Washington prior authorization

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