81504 prior authorization | Blue Cross and Blue Shield of Montana

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 Blue Cross and Blue Shield of Montana commercial 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: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 152 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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