Q2054 prior authorization | Anthem Blue Cross Blue Shield of Georgia

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 Blue Shield of Georgia 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: Standard Local Prior Authorization Code List, Pg 118 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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