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… Authorization Information • Policy History Policy Number: 159 BCBSA Reference Number: N/A NCD/LCD: N/A Related Policies … … 6961 … Treatments … 06/08/2023 … 159 … application/pdf …
… see policy 158 Prior authorization is required; in effect 159 Gene Therapies for Bladder Cancer Complete Prior … Manager All commercial products For CPT codes, see policy 159. Prior authorization is required. Effective 6.8.2023. 168 … al-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
… subsequent encounter for fracture with delayed healing 159 S32.609K Unspecified fracture of unspecified ischium, … right thigh M60.152 Interstitial myositis, left thigh M60.159 Interstitial myositis, unspecified thigh M60.161 … femur M87.152 Osteonecrosis due to drugs, left femur M87.159 Osteonecrosis due to drugs, unspecified femur M87.250 …
… hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic … hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic … verbal response, incomprehensible words, unspecified time 159 R40.2221 Coma scale, best verbal response, …
… Encounter For Open Fracture Type Iiia, Iiib, Or Iiic 159 S52.345D Nondisplaced Spiral Fracture Of Shaft Of Radius, …
… lacrimal gland atrophy, bilateral lacrimal glands H04.159 Secondary lacrimal gland atrophy, unspecified lacrimal … right hip M00.152 Pneumococcal arthritis, left hip M00.159 Pneumococcal arthritis, unspecified hip M00.161 … hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic …
… spondylolisthesis of seventh cervical vertebra, sequela 159 S12.631A Unspecified traumatic nondisplaced …
… Laceration of popliteal vein, left leg, initial encounter 159 S85.512D Laceration of popliteal vein, left leg, …
411 Directory of Documents.pdf550.44 KB
… Stimulation 636 Gene Therapies for Bladder Cancer 159 Genotype-Guided Tamoxifen Treatment 067 Hematopoietic … al-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
999 Medical Policy Updates prn.pdf939.92 KB
… Actions required Gene Therapies for Bladder Cancer 159 New medical policy describing medically necessary and …
… Shield of Massachusetts Pre-certification Request Form MP 159 Gene Therapies for Bladder Cancer No LCD or NCD BCBSMA … from MP #400 and transferred to MP #165. 52 7/2023 MP #159 Gene Therapies for Bladder Cancer added. Effective …