Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 12
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 |
|---|---|---|
| 0539U | Oncology (solid tumor), cell-free circulatin | New Hampshire Precertification List, Pg 61 Original policy |
| 0540T | Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous | New Hampshire Precertification List, Pg 61 Original policy |
| 0540U | Transplantation medicine, quantification o | New Hampshire Precertification List, Pg 61 Original policy |
| 0541U | Cardiovascular disease (HDL reverse cho | New Hampshire Precertification List, Pg 61 Original policy |
| 0543U | Oncology (solid tumor), next-generation s | New Hampshire Precertification List, Pg 61 Original policy |
| 0544T | Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture | New Hampshire Precertification List, Pg 61 Original policy |
| 0544U | Nephrology (transplant monitoring), 48 var | New Hampshire Precertification List, Pg 61 Original policy |
| 0545T | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach | New Hampshire Precertification List, Pg 61 Original policy |
| 0546T | Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report | New Hampshire Precertification List, Pg 61 Original policy |
| 0549U | Oncology (urothelial), DNA, quantitative m | New Hampshire Precertification List, Pg 61 Original policy |
| 0550U | Oncology (prostate), enzyme-linked immu | New Hampshire Precertification List, Pg 62 Original policy |
| 0552T | Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional | New Hampshire Precertification List, Pg 62 Original policy |
| 0552U | Reproductive medicine (preimplantation g | New Hampshire Precertification List, Pg 62 Original policy |
| 0553U | Reproductive medicine (preimplantation g | New Hampshire Precertification List, Pg 62 Original policy |
| 0554U | Reproductive medicine (preimplantation g | New Hampshire Precertification List, Pg 62 Original policy |
| 0555U | Reproductive medicine (preimplantation g | New Hampshire Precertification List, Pg 62 Original policy |
| 0560U | Oncology (minimal residual disease [MRD | New Hampshire Precertification List, Pg 62 Original policy |
| 0561U | Oncology (minimal residual disease [MRD | New Hampshire Precertification List, Pg 62 Original policy |
| 0562U | Oncology (solid tumor), targeted genomic | New Hampshire Precertification List, Pg 62 Original policy |
| 0563T | Evacuation of meibomian glands, using heat delivered through wearable, open- eye eyelid treatment devices and manual gland expression, bilateral | New Hampshire Precertification List, Pg 62 Original policy |
| 0565T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation | New Hampshire Precertification List, Pg 62 Original policy |
| 0565U | Oncology (hepatocellular carcinoma), next | New Hampshire Precertification List, Pg 62 Original policy |
| 0566T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral | New Hampshire Precertification List, Pg 62 Original policy |
| 0566U | Oncology (lung), qPCR-based analysis of | New Hampshire Precertification List, Pg 62 Original policy |
| 0567U | Rare diseases (constitutional/heritable dis | New Hampshire Precertification List, Pg 62 Original policy |
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | New Hampshire Precertification List, Pg 62 Original policy |
| 0569U | Oncology (solid tumor), next-generation s | New Hampshire Precertification List, Pg 62 Original policy |
| 0571T | Insertion or replacement of implantable ca | New Hampshire Precertification List, Pg 62 Original policy |
| 0571U | Oncology (solid tumor), DNA (80 genes) a | New Hampshire Precertification List, Pg 62 Original policy |
| 0572T | Insertion of substernal implantable defibrill | New Hampshire Precertification List, Pg 62 Original policy |
| 0573T | Removal of substernal implantable defibrill | New Hampshire Precertification List, Pg 62 Original policy |
| 0574T | Repositioning of previously implanted sub | New Hampshire Precertification List, Pg 62 Original policy |
| 0575U | Transplantation medicine (liver allograft rejection), miRNA gene expression profiling by RT-PCR of 4 genes (miR- 122, miR-885, miR-23a housekeeping, spike-in control), serum, a | New Hampshire Precertification List, Pg 62 Original policy |
| 0576U | Transplantation medicine (liver allograft rejection), quantitative donor-derived cell- free DNA (cfDNA) by whole genome next- generation sequencing, plasma and mRNA gene express | New Hampshire Precertification List, Pg 62 Original policy |
| 0578U | Oncology (cutaneous melanoma), RNA, gene expression profiling by real-time qPCR of 10 genes (8 content and 2 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) t | New Hampshire Precertification List, Pg 62 Original policy |
| 0580T | Removal of substernal implantable defibrill | New Hampshire Precertification List, Pg 62 Original policy |
| 0581T | Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral | New Hampshire Precertification List, Pg 63 Original policy |
| 0582U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome DNA sequencing for single-nucleotide variants, insertions/deletions, copy number variations, bl | New Hampshire Precertification List, Pg 63 Original policy |
| 0583U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome comparator DNA sequencing for single-nucleotide variants, insertions/deletions, copy number var | New Hampshire Precertification List, Pg 63 Original policy |
| 0584T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; percutaneous | New Hampshire Precertification List, Pg 63 Original policy |
| 0585T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; laparoscopic | New Hampshire Precertification List, Pg 63 Original policy |
| 0585U | Targeted genomic sequence analysis panel, solid organ neoplasm, circulating cell-free DNA (cfDNA) analysis from plasma of 521 genes, interrogation for sequence variants, gene | New Hampshire Precertification List, Pg 63 Original policy |
| 0586T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; open | New Hampshire Precertification List, Pg 63 Original policy |
| 0586U | Oncology, mRNA, gene expression profiling of 216 genes (204 targeted and 12 housekeeping genes), RNA expression analysis, formalin-fixed paraffin-embedded (FFPE) tissue, quant | New Hampshire Precertification List, Pg 63 Original policy |
| 0587T | Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve | New Hampshire Precertification List, Pg 63 Original policy |
| 0588T | Revision or removal of percutaneously placed integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve | New Hampshire Precertification List, Pg 64 Original policy |
| 0589U | Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 24 PFAS compounds by high-performance liquid chromatography with tandem mass spec | New Hampshire Precertification List, Pg 64 Original policy |
| 0592U | Oncology (hematolymphoid neoplasms), DNA, targeted genomic sequence of 417 genes, interrogation for gene fusions, translocations, rearrangements, utilizing formalin-fixed para | New Hampshire Precertification List, Pg 64 Original policy |
| 0596T | Temporary female intraurethral valve- pump (ie, voiding prosthesis); initial insertion, including urethral measurement | New Hampshire Precertification List, Pg 64 Original policy |
| 0597T | Temporary female intraurethral valve- pump (ie, voiding prosthesis); replacement | New Hampshire Precertification List, Pg 64 Original policy |