0228U prior authorization | Premera Blue Cross of Washington

0228U, Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0228U
Description: Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morning voided urine, algorithm reported as likelihood of prostate cancer
Source: Clinical Review by Code List PBCWA, Pg 47 Original policy

Premera Blue Cross of Washington prior authorization

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