0517U prior authorization | Blue Shield of California Promise Health Plan

0517U, Therapeutic drug monitoring, 80 or more psychoactive drugs or substances, lc-ms/ms, plasma, qualitative and quantitative therapeutic minimally and maximally effective dose of prescribed and non-prescribed medications, is on the Blue Shield of California Promise Health Plan Medi-Cal prior authorization list. Not a coverage or referral decision.

Code: 0517U
Description: Therapeutic drug monitoring, 80 or more psychoactive drugs or substances, lc-ms/ms, plasma, qualitative and quantitative therapeutic minimally and maximally effective dose of prescribed and non-prescribed medications
Source: Medi-Cal Prior Authorization List, Pg 17 Original policy

Blue Shield of California Promise Health Plan prior authorization

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