Q2043 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

Q2043, Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap- gm-csf, including leukapheresis and all other preparatory procedures, per infusion, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: Q2043
Description: Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap- gm-csf, including leukapheresis and all other preparatory procedures, per infusion
Source: New Hampshire Precertification List, Pg 253 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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