81195 prior authorization | Blue Cross and Blue Shield of Montana

81195, Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM), is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 81195
Description: Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM)
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 106 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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