Q2055 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

Q2055, Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed 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: Q2055
Description: Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed CAR-positive 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

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