81504 prior authorization | Anthem Blue Cross Blue Shield of Georgia

81504, Oncology (tissue of origin), microarray gene expression profiling of• 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 81504
Description: Oncology (tissue of origin), microarray gene expression profiling of• 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores
Source: Standard Local Prior Authorization Code List, Pg 52 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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