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0220U - Oncology (breast cancer), AI-based image analysis of 12 histologic & immunohistochemical features (recurrence All

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Procedure / ServiceOncology (breast cancer), AI-based image analysis of 12 histologic & immunohistochemical features (recurrence All
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - Diagnostics continued Infectious agent (HIV), targeted viral NGS (protease, reverse transcriptase, integrase) with algorithm for antiviral 0219U All drug susceptibility Oncology (breast cancer), AI-based image analysis of 12 histologic & immunohistochemical features (recurrence 0220U All score) Gallium Ga-68 Dotatoc, diagnostic (0.01 mci) C9067 All

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  • Submit clinical notes if requested by the plan
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