Q2054 prior authorization | Anthem Blue Cross and Blue Shield Virginia

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 Virginia HMO/EPO 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: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 75 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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