Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 24
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 |
|---|---|---|
| 32855 | Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; unilateral | New Hampshire Precertification List, Pg 105 Original policy |
| 32856 | Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral | New Hampshire Precertification List, Pg 105 Original policy |
| 32994 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation | New Hampshire Precertification List, Pg 105 Original policy |
| 32998 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency | New Hampshire Precertification List, Pg 105 Original policy |
| 33140 | Transmyocardial laser revascularization, by thoracotomy; (separate procedure) | New Hampshire Precertification List, Pg 105 Original policy |
| 33202 | Insertion of epicardial electrodes(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach) | New Hampshire Precertification List, Pg 105 Original policy |
| 33203 | endoscopic approach (eg, thoracoscopy, pericardioscopy) | New Hampshire Precertification List, Pg 106 Original policy |
| 33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | New Hampshire Precertification List, Pg 106 Original policy |
| 33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | New Hampshire Precertification List, Pg 106 Original policy |
| 33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | New Hampshire Precertification List, Pg 106 Original policy |
| 33212 | Insertion of pacemaker pulse generator only; with existing single lead | New Hampshire Precertification List, Pg 106 Original policy |
| 33213 | Insertion of pacemaker pulse generator only; with existing dual leads | New Hampshire Precertification List, Pg 106 Original policy |
| 33214 | Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) | New Hampshire Precertification List, Pg 106 Original policy |
| 33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | New Hampshire Precertification List, Pg 106 Original policy |
| 33216 | Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator | New Hampshire Precertification List, Pg 106 Original policy |
| 33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter- defibrillator | New Hampshire Precertification List, Pg 106 Original policy |
| 33218 | Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator | New Hampshire Precertification List, Pg 106 Original policy |
| 33220 | Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter-defibrillator | New Hampshire Precertification List, Pg 106 Original policy |
| 33222 | Relocation of skin pocket for pacemaker | New Hampshire Precertification List, Pg 106 Original policy |
| 33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) | New Hampshire Precertification List, Pg 106 Original policy |
| 33225 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) | New Hampshire Precertification List, Pg 107 Original policy |
| 33226 | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) | New Hampshire Precertification List, Pg 107 Original policy |
| 33227 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33228 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33229 | Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33230 | Insertion of implantable defibrillator pulse generator only; with existing dual leads | New Hampshire Precertification List, Pg 107 Original policy |
| 33231 | Insertion of implantable defibrillator pulse generator only; with existing multiple leads | New Hampshire Precertification List, Pg 107 Original policy |
| 33233 | Removal of permanent pacemaker pulse generator only | New Hampshire Precertification List, Pg 107 Original policy |
| 33234 | Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular | New Hampshire Precertification List, Pg 107 Original policy |
| 33235 | Removal of transvenous pacemaker electrode(s); dual lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33240 | Insertion of pacing cardioverter- defibrillator pulse generator only; with existing single lead | New Hampshire Precertification List, Pg 107 Original policy |
| 33249 | Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber | New Hampshire Precertification List, Pg 107 Original policy |
| 33262 | Removal Of Pacing Cardioverter-Defibrilla | New Hampshire Precertification List, Pg 107 Original policy |
| 33263 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33264 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system | New Hampshire Precertification List, Pg 107 Original policy |
| 33267 | Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | New Hampshire Precertification List, Pg 108 Original policy |
| 33269 | Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | New Hampshire Precertification List, Pg 108 Original policy |
| 33270 | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed | New Hampshire Precertification List, Pg 108 Original policy |
| 33271 | Insertion of subcutaneous implantable defibrillator electrode | New Hampshire Precertification List, Pg 108 Original policy |
| 33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed | New Hampshire Precertification List, Pg 108 Original policy |
| 33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed | New Hampshire Precertification List, Pg 108 Original policy |
| 33276 | Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial analysis with diagnostic mode activation, when performed | New Hampshire Precertification List, Pg 108 Original policy |
| 33278 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; system, including pulse generator and lead(s) | New Hampshire Precertification List, Pg 108 Original policy |
| 33279 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sensing lead(s) only | New Hampshire Precertification List, Pg 108 Original policy |
| 33280 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator only | New Hampshire Precertification List, Pg 109 Original policy |
| 33281 | Repositioning of phrenic nerve stimulator transvenous lead(s) | New Hampshire Precertification List, Pg 109 Original policy |
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | New Hampshire Precertification List, Pg 109 Original policy |
| 33287 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator | New Hampshire Precertification List, Pg 109 Original policy |
| 33288 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sensing lead(s) | New Hampshire Precertification List, Pg 109 Original policy |
| 33289 | Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed | New Hampshire Precertification List, Pg 109 Original policy |