0413U prior authorization | Premera Blue Cross of Washington

0413U, Oncology optical genome mapping for copy number alterations, aneuploidy & balanced/complex structural rearrangements, DNA from blood or bone marrow, RPT of clinically significance alt, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0413U
Description: Oncology optical genome mapping for copy number alterations, aneuploidy & balanced/complex structural rearrangements, DNA from blood or bone marrow, RPT of clinically significance alt
Source: Clinical Review by Code List PBCWA, Pg 81 Original policy

Premera Blue Cross of Washington prior authorization

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