81504 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

81504, Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin- embedded tissue, algorithm reported as tissue similarity scores, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 81504
Description: Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin- embedded tissue, algorithm reported as tissue similarity scores
Source: New Hampshire Precertification List, Pg 179 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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