Q2053 prior authorization | Premera Blue Cross of Washington
Q2053, Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- Q2053
- Description
- Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- Source
- Clinical Review by Code List PBCWA, Pg 772 Original policy