0017M prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
0017M, Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.
- Code
- 0017M
- Description
- Oncology (diffuse large B-cell lymphoma [DLBCL]), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin
- Source
- New Hampshire Precertification List, Pg 16 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization