0020M prior authorization | Premera Blue Cross of Washington

0020M, Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0020M
Description: Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass
Source: Clinical Review by Code List PBCWA, Pg 17 Original policy

Premera Blue Cross of Washington prior authorization

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