Q2055 prior authorization | Premera Blue Cross of Washington

Q2055, Idecabtagene vicleucel, up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive 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: Q2055
Description: Idecabtagene vicleucel, up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Source: Clinical Review by Code List PBCWA, Pg 773 Original policy

Premera Blue Cross of Washington prior authorization

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