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0576U prior authorization | Blue Cross Blue Shield Oklahoma

0576U, Transplantation medicine (liver allograft rejection), quantitative donor- derived cell-free DNA (cfDNA) by (cid:90)(cid:75)(cid:82)(cid:79)(cid:72)(cid:3)(cid:74)(cid:72)(cid:81)(cid:82)(cid:80)(cid:72)(cid:3)(cid:81)(cid:72)(cid:91)(cid:87)(cid:31)(cid:74)(cid:72)(cid:81)(cid:72)(cid:85)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3) sequencing, plasma and mRNA gene expression profiling by multiplex real-time PCR of 56 genes, whole blood, combined algorithm reported as a rejection risk score, is on the Blue Cross Blue Shield Oklahoma commercial prior authorization list. Not a coverage or referral decision.

Code
0576U
Description
Transplantation medicine (liver allograft rejection), quantitative donor- derived cell-free DNA (cfDNA) by (cid:90)(cid:75)(cid:82)(cid:79)(cid:72)(cid:3)(cid:74)(cid:72)(cid:81)(cid:82)(cid:80)(cid:72)(cid:3)(cid:81)(cid:72)(cid:91)(cid:87)(cid:31)(cid:74)(cid:72)(cid:81)(cid:72)(cid:85)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3) sequencing, plasma and mRNA gene expression profiling by multiplex real-time PCR of 56 genes, whole blood, combined algorithm reported as a rejection risk score
Source
2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 44 Original policy

Blue Cross Blue Shield Oklahoma prior authorization

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