Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 11
CPT code lookup
Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.
Prior authorization codes
| Code | Description | Source |
|---|---|---|
| 0496U | Oncology (colorectal), cell-free DNA, 8 ge | New Hampshire Precertification List, Pg 58 Original policy |
| 0497U | Oncology (prostate), mRNA gene-express | New Hampshire Precertification List, Pg 58 Original policy |
| 0498U | Oncology (colorectal), next-generation seq | New Hampshire Precertification List, Pg 58 Original policy |
| 0499U | Oncology (colorectal and lung), DNA from | New Hampshire Precertification List, Pg 58 Original policy |
| 0500U | Autoinflammatory disease (VEXAS syndro | New Hampshire Precertification List, Pg 58 Original policy |
| 0503U | Neurology (Alzheimer disease), beta amyloid (AB40, AB42, AB42/40 ratio) and tau-protein (ptau217, np-tau217, ptau217/np-tau217 ratio), blood, immunoprecipitation with quantita | New Hampshire Precertification List, Pg 58 Original policy |
| 0505T | Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion | New Hampshire Precertification List, Pg 58 Original policy |
| 0506U | Gastroenterology (Barrett's esophagus), e | New Hampshire Precertification List, Pg 58 Original policy |
| 0507U | Oncology (ovarian), DNA, whole-genome | New Hampshire Precertification List, Pg 58 Original policy |
| 0508U | Transplantation medicine, quantification o | New Hampshire Precertification List, Pg 58 Original policy |
| 0509U | Transplantation medicine, quantification o | New Hampshire Precertification List, Pg 58 Original policy |
| 0510T | Removal of sinus tarsi implant | New Hampshire Precertification List, Pg 58 Original policy |
| 0511T | Removal and reinsertion of sinus tarsi implant | New Hampshire Precertification List, Pg 58 Original policy |
| 0511U | Oncology (solid tumor), tumor cell culture in 3D microenvironment, 36 or more drug panel, reported as tumor-response prediction for each drug | New Hampshire Precertification List, Pg 58 Original policy |
| 0512T | Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; initial wound | New Hampshire Precertification List, Pg 59 Original policy |
| 0515T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery]) | New Hampshire Precertification List, Pg 59 Original policy |
| 0516T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; electrode only | New Hampshire Precertification List, Pg 59 Original policy |
| 0516U | Drug metabolism, whole blood, pharmaco | New Hampshire Precertification List, Pg 59 Original policy |
| 0517T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performed; both components of pulse generator (battery and transmitter) only | New Hampshire Precertification List, Pg 59 Original policy |
| 0518T | Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; battery component only | New Hampshire Precertification List, Pg 59 Original policy |
| 0519T | Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; both components (battery and transmitter) | New Hampshire Precertification List, Pg 59 Original policy |
| 0520T | Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only | New Hampshire Precertification List, Pg 59 Original policy |
| 0521T | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimulator for left ventricular pacing | New Hampshire Precertification List, Pg 59 Original policy |
| 0521U | Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood | New Hampshire Precertification List, Pg 59 Original policy |
| 0522T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, wireless cardiac stimulator for left ventricular pacing | New Hampshire Precertification List, Pg 60 Original policy |
| 0523U | Oncology (solid tumor), DNA, qualitative | New Hampshire Precertification List, Pg 60 Original policy |
| 0524T | Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation, diagnostic imaging, imaging guidance and monitoring | New Hampshire Precertification List, Pg 60 Original policy |
| 0524U | Obstetrics (preeclampsia), sFlt-1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value | New Hampshire Precertification List, Pg 60 Original policy |
| 0525T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor) | New Hampshire Precertification List, Pg 60 Original policy |
| 0525U | Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib) ovarian, fallopian, or peritoneal response prediction for each drug | New Hampshire Precertification List, Pg 60 Original policy |
| 0526T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; electrode only | New Hampshire Precertification List, Pg 60 Original policy |
| 0527T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; implantable monitor only | New Hampshire Precertification List, Pg 60 Original policy |
| 0528T | Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report | New Hampshire Precertification List, Pg 60 Original policy |
| 0529T | Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report | New Hampshire Precertification List, Pg 60 Original policy |
| 0529U | Hematology (venous thromboembolism [V | New Hampshire Precertification List, Pg 60 Original policy |
| 0530T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; complete system (electrode and implantable monitor) | New Hampshire Precertification List, Pg 61 Original policy |
| 0530U | Oncology (pan-solid tumor), ctDNA, utilizin | New Hampshire Precertification List, Pg 61 Original policy |
| 0531T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; electrode only | New Hampshire Precertification List, Pg 61 Original policy |
| 0531U | Infectious disease (acid-fast bacteria and | New Hampshire Precertification List, Pg 61 Original policy |
| 0532T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only | New Hampshire Precertification List, Pg 61 Original policy |
| 0532U | Rare diseases (constitutional disease/here | New Hampshire Precertification List, Pg 61 Original policy |
| 0533U | Drug metabolism (adverse drug reactions | New Hampshire Precertification List, Pg 61 Original policy |
| 0534U | Oncology (prostate), microRNA, single-nu | New Hampshire Precertification List, Pg 61 Original policy |
| 0535U | Perfluoroalkyl substances (PFAS) (eg, per | New Hampshire Precertification List, Pg 61 Original policy |
| 0536U | Red blood cell antigen (fetal RhD), PCR a | New Hampshire Precertification List, Pg 61 Original policy |
| 0537T | Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day | New Hampshire Precertification List, Pg 61 Original policy |
| 0537U | Oncology (colorectal cancer), analysis of c | New Hampshire Precertification List, Pg 61 Original policy |
| 0538T | Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage) | New Hampshire Precertification List, Pg 61 Original policy |
| 0538U | Oncology (solid tumor), next-generation ta | New Hampshire Precertification List, Pg 61 Original policy |
| 0539T | Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR- T cells for administration | New Hampshire Precertification List, Pg 61 Original policy |