0004M prior authorization | Premera Blue Cross of Washington

0004M, Scoliosis, DNA analysis of 53 single nucleotide polymorphisms (SNPs), using saliva, prognostic algorithm reported as a risk score These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0004M
Description: Scoliosis, DNA analysis of 53 single nucleotide polymorphisms (SNPs), using saliva, prognostic algorithm reported as a risk score These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 12 Original policy

Premera Blue Cross of Washington prior authorization

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