0255U prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

0255U, Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 0255U
Description: Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score
Source: New Hampshire Precertification List, Pg 35 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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