Q2041 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

Q2041, Axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: Q2041
Description: Axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Source: New Hampshire Precertification List, Pg 253 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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