| BCBS Massachusetts | Gene Therapy for Spinal Muscular Atrophy (SMA) Prior Authorization Request Form | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Breast Surgical Procedures, MPM 27.0 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Capsule Endoscopy, MPM 24.0 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Durable Medical Equipment: Positive Airway Pressure (PAP) and Oral Appliances for Treatment of Obstructive Sleep Apnea, MPM 49.1 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Gastric Electric Stimulation for the Treatment of Chronic Gastroparesis, MPM 7.2 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Genetic Testing for Pancreatic Cyst (PathfinderTG®/PancraGen™), MPM 7.6 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Genetic Testing for Uveal Melanoma, MPM 7.9 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Obstetric US 3D, 4D, 5D, MPM 15.4 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Transcranial Magnetic Stimulation (TMS) for Treatment Resistant Depression, MPM 20.11 | |
| Presbyterian Health Plan | .css-1q60w1m{display:inherit;margin-right:8px;margin-left:-4px;margin-left:0;}Vagus Nerve Stimulation for Epilepsy and Depression, MPM 22.4 | |