Q2053 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
Q2053, Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable 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
- Q2053
- Description
- Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- Source
- New Hampshire Precertification List, Pg 254 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization