Q2041 prior authorization | Blue Cross and Blue Shield of Montana

Q2041, Axicabtagene Ciloleucel Up BCBSMT To 200 Million Autologous Anti- Cd19 Car Positive Viable T Cells Including Leukapheresis And Dose Preparation Procedures Per Therapeutic Dose, is on the Blue Cross and Blue Shield of Montana prior authorization list. Not a coverage or referral decision.

Code: Q2041
Description: Axicabtagene Ciloleucel Up BCBSMT To 200 Million Autologous Anti- Cd19 Car Positive Viable T Cells Including Leukapheresis And Dose Preparation Procedures Per Therapeutic Dose
Source: 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 24 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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