Q2043 prior authorization | Premera Blue Cross of Washington

Q2043, Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap- gm-csf, including leukapheresis and all other preparatory procedures, per infusion, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: Q2043
Description: Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap- gm-csf, including leukapheresis and all other preparatory procedures, per infusion
Source: Clinical Review by Code List PBCWA, Pg 772 Original policy

Premera Blue Cross of Washington prior authorization

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