81244 prior authorization | Premera Blue Cross of Washington

81244, FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability (XLID)) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 81244
Description: FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability (XLID)) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 453 Original policy

Premera Blue Cross of Washington prior authorization

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