J3401 prior authorization | Premera Blue Cross of Washington

J3401, Beremagene geperpavec-svdt for topical administration, containing nominal 5x10^9 pfu/ml vector genomes, per 0.1 ml 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: J3401
Description: Beremagene geperpavec-svdt for topical administration, containing nominal 5x10^9 pfu/ml vector genomes, per 0.1 ml These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 716 Original policy

Premera Blue Cross of Washington prior authorization

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