0118U prior authorization | Premera Blue Cross of Washington

0118U, Transplantation medicine, quantification of donor-derived cell-free DNA using whole genome next-generation sequencing, plasma, reported as percentage of donor- derived cell-free DNA in the total cell-free DNA 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: 0118U
Description: Transplantation medicine, quantification of donor-derived cell-free DNA using whole genome next-generation sequencing, plasma, reported as percentage of donor- derived cell-free DNA in the total cell-free DNA These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 29 Original policy

Premera Blue Cross of Washington prior authorization

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