81172 prior authorization | Premera Blue Cross of Washington

81172, AFF2 (ALF transcription elongation factor 2 (FMR2) (EF, fragile X intellectual disability 2 (FRAXE) gene analysis; characterization of alleles (eg, expanded size and methylation status), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 81172
Description: AFF2 (ALF transcription elongation factor 2 (FMR2) (EF, fragile X intellectual disability 2 (FRAXE) gene analysis; characterization of alleles (eg, expanded size and methylation status)
Source: Clinical Review by Code List PBCWA, Pg 440 Original policy

Premera Blue Cross of Washington prior authorization

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