81422 prior authorization | Premera Blue Cross of Washington

81422, Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood 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: 81422
Description: Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 483 Original policy

Premera Blue Cross of Washington prior authorization

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