Q2054 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
Q2054, Lisocabtagene maraleucel, up to 110 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
- Q2054
- Description
- Lisocabtagene maraleucel, up to 110 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