81170 prior authorization | Premera Blue Cross of Washington

81170, ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 81170
Description: ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain
Source: Clinical Review by Code List PBCWA, Pg 440 Original policy

Premera Blue Cross of Washington prior authorization

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