81541 prior authorization | Premera Blue Cross of Washington

81541, Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 81541
Description: Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score
Source: Clinical Review by Code List PBCWA, Pg 498 Original policy

Premera Blue Cross of Washington prior authorization

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