81465 prior authorization | Premera Blue Cross of Washington

81465, Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 81465
Description: Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed
Source: Clinical Review by Code List PBCWA, Pg 492 Original policy

Premera Blue Cross of Washington prior authorization

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