0657U prior authorization | Premera Blue Cross of Washington

0657U, Rare diseases (constitutional/heritable disorders), rapid whole genome sequence analysis of comparator nuclear and mitochondrial DNA by next-generation sequencing (NGS), using blood or buccal sample, relevant variants reported with proband results, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 0657U
Description: Rare diseases (constitutional/heritable disorders), rapid whole genome sequence analysis of comparator nuclear and mitochondrial DNA by next-generation sequencing (NGS), using blood or buccal sample, relevant variants reported with proband results
Source: Clinical Review by Code List PBCWA, Pg 142 Original policy

Premera Blue Cross of Washington prior authorization

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