Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 53
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 |
|---|---|---|
| E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest | New Hampshire Precertification List, Pg 225 Original policy |
| E0660 | Nonsegmental pneumatic appliance for use with pneumatic compressor, full leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0665 | Nonsegmental pneumatic appliance for use with pneumatic compressor, full arm | New Hampshire Precertification List, Pg 225 Original policy |
| E0666 | Nonsegmental pneumatic appliance for use with pneumatic compressor, half leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0667 | Segmental pneumatic appliance for use with pneumatic compressor, full leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0668 | Segmental pneumatic appliance for use with pneumatic compressor, full arm | New Hampshire Precertification List, Pg 225 Original policy |
| E0669 | Segmental pneumatic appliance for use with pneumatic compressor, half leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0670 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, two full legs and trunk | New Hampshire Precertification List, Pg 225 Original policy |
| E0671 | Segmental gradient pressure pneumatic appliance, full leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0672 | Segmental gradient pressure pneumatic appliance, full arm | New Hampshire Precertification List, Pg 225 Original policy |
| E0673 | Segmental gradient pressure pneumatic appliance, half leg | New Hampshire Precertification List, Pg 225 Original policy |
| E0676 | Intermittent limb compression device (includes all accessories), not otherwise specified | New Hampshire Precertification List, Pg 225 Original policy |
| E0677 | Non-pneumatic sequential compression g | New Hampshire Precertification List, Pg 225 Original policy |
| E0678 | Non-pneumatic sequential compression g | New Hampshire Precertification List, Pg 225 Original policy |
| E0679 | Non-pneumatic sequential compression g | New Hampshire Precertification List, Pg 225 Original policy |
| E0680 | Non-pneumatic compression controller wit | New Hampshire Precertification List, Pg 225 Original policy |
| E0681 | Non-pneumatic compression controller wit | New Hampshire Precertification List, Pg 225 Original policy |
| E0682 | Non-pneumatic sequential compression g | New Hampshire Precertification List, Pg 225 Original policy |
| E0683 | Non-pneumatic, non-sequential, peristaltic | New Hampshire Precertification List, Pg 226 Original policy |
| E0721 | Transcutaneous electrical nerve stimulatory, stimulates nerves in the auricular region | New Hampshire Precertification List, Pg 226 Original policy |
| E0732 | Cranial electrotherapy stimulation (CES) system, any type | New Hampshire Precertification List, Pg 226 Original policy |
| E0734 | External upper limb tremor stimulator of the peripheral nerves of the wrist | New Hampshire Precertification List, Pg 226 Original policy |
| E0735 | Noninvasive vagus nerve stimulator | New Hampshire Precertification List, Pg 226 Original policy |
| E0736 | Transcutaneous tibial nerve stimulator | New Hampshire Precertification List, Pg 226 Original policy |
| E0737 | Transcutaneous tibial nerve stimulator, controlled by phone application | New Hampshire Precertification List, Pg 226 Original policy |
| E0738 | Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, includes microprocessor, all components and accessories | New Hampshire Precertification List, Pg 226 Original policy |
| E0739 | Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors | New Hampshire Precertification List, Pg 226 Original policy |
| E0743 | External lower extremity nerve stimulator for restless legs syndrome, each | New Hampshire Precertification List, Pg 226 Original policy |
| E0745 | Neuromuscular stimulator, electronic shock unit | New Hampshire Precertification List, Pg 226 Original policy |
| E0746 | Electromyography (EMG), biofeedback device | New Hampshire Precertification List, Pg 226 Original policy |
| E0748 | Osteogenesis stimulator, electrical, noninvasive, spinal applications | New Hampshire Precertification List, Pg 226 Original policy |
| E0760 | Osteogenesis stimulator, low intensity ultrasound, noninvasive | New Hampshire Precertification List, Pg 226 Original policy |
| E0761 | Nonthermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device | New Hampshire Precertification List, Pg 226 Original policy |
| E0762 | Transcutaneous electrical joint stimulation device system, includes all accessories | New Hampshire Precertification List, Pg 226 Original policy |
| E0764 | Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program | New Hampshire Precertification List, Pg 226 Original policy |
| E0765 | FDA-approved nerve stimulator, for treatment of nausea and vomiting | New Hampshire Precertification List, Pg 226 Original policy |
| E0769 | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified | New Hampshire Precertification List, Pg 226 Original policy |
| E0770 | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified | New Hampshire Precertification List, Pg 227 Original policy |
| E0986 | Manual wheelchair accessory, push-rim activated power assist system | New Hampshire Precertification List, Pg 227 Original policy |
| E1002 | Wheelchair accessory, power seating system, tilt only | New Hampshire Precertification List, Pg 227 Original policy |
| E1003 | Wheelchair accessory, power seating system, recline only, without shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1004 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1005 | Wheelchair accessory, power seating system, recline only, with power shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1006 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1007 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1008 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction | New Hampshire Precertification List, Pg 227 Original policy |
| E1230 | Power operated vehicle (three- or four- wheel nonhighway), specify brand name and model number | New Hampshire Precertification List, Pg 227 Original policy |
| E1700 | Jaw motion rehabilitation system | New Hampshire Precertification List, Pg 227 Original policy |
| E1701 | Replacement cushions for jaw motion rehabilitation system, package of 6 | New Hampshire Precertification List, Pg 227 Original policy |
| E1702 | Replacement measuring scales for jaw motion rehabilitation system, package of 200 | New Hampshire Precertification List, Pg 227 Original policy |