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Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 60

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

Prior authorization codes
CodeDescriptionSource
J7171Injection, ADAMTS13, recombinant-krhn, 10 IUNew Hampshire Precertification List, Pg 241 Original policy
J7172Injection, marstacimab-hncq, 0.5 mgNew Hampshire Precertification List, Pg 241 Original policy
J7175Injection, Factor X, (human), 1 IUNew Hampshire Precertification List, Pg 241 Original policy
J7177Injection, human fibrinogen concentrate (Fibryga), 1 mgNew Hampshire Precertification List, Pg 241 Original policy
J7178Injection, human fibrinogen concentrate, not otherwise specified, 1 mgNew Hampshire Precertification List, Pg 241 Original policy
J7179Injection, von Willebrand factor (recombinant), (Vonvendi), 1 IU VWF:RCoNew Hampshire Precertification List, Pg 241 Original policy
J7180Injection, Factor XIII (antihemophilic factor, human), 1 IUNew Hampshire Precertification List, Pg 241 Original policy
J7181Injection, Factor XIII A-subunit, (recombinant), per IUNew Hampshire Precertification List, Pg 241 Original policy
J7182Injection, Factor VIII, (antihemophilic factor, recombinant), (NovoEight), per IUNew Hampshire Precertification List, Pg 241 Original policy
J7183Injection, von Willebrand factor complex (human), Wilate, 1 IU VWF:RCONew Hampshire Precertification List, Pg 241 Original policy
J7185Injection, Factor VIII (antihemophilic factor, recombinant) (Xyntha), per IUNew Hampshire Precertification List, Pg 241 Original policy
J7186Injection, antihemophilic Factor VIII/von Willebrand factor complex (human), per Factor VIII IUNew Hampshire Precertification List, Pg 241 Original policy
J7187Injection, von Willebrand factor complex (Humate-P), per IU VWF:RCONew Hampshire Precertification List, Pg 241 Original policy
J7188Injection, Factor VIII (antihemophilic factor, recombinant) (Obizur), per IUNew Hampshire Precertification List, Pg 241 Original policy
J7189Factor VIIa (antihemophilic factor, recombinant), (NovoSeven RT), 1 mcgNew Hampshire Precertification List, Pg 241 Original policy
J7190Factor VIII (antihemophilic factor, human) per IUNew Hampshire Precertification List, Pg 241 Original policy
J7191Factor VIII (antihemophilic factor (porcine)), per IUNew Hampshire Precertification List, Pg 241 Original policy
J7192Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specifiedNew Hampshire Precertification List, Pg 241 Original policy
J7193Factor IX (antihemophilic factor, purified, nonrecombinant) per IUNew Hampshire Precertification List, Pg 241 Original policy
J7194Factor IX complex, per IUNew Hampshire Precertification List, Pg 242 Original policy
J7195Injection, Factor IX (antihemophilic factor, recombinant) per IU, not otherwise specifiedNew Hampshire Precertification List, Pg 242 Original policy
J7198Antiinhibitor, per IUNew Hampshire Precertification List, Pg 242 Original policy
J7200Injection, Factor IX, (antihemophilic factor, recombinant), Rixubis, per IUNew Hampshire Precertification List, Pg 242 Original policy
J7201Injection, Factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7202Injection, Factor IX, albumin fusion protein, (recombinant), Idelvion, 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7203Injection Factor IX, (antihemophilic factor, recombinant), glycoPEGylated, (Rebinyn), 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7204Injection, Factor VIII, antihemophilic factor (recombinant), (Esperoct), glycopegylated-exei, per IUNew Hampshire Precertification List, Pg 242 Original policy
J7205Injection, Factor VIII Fc fusion protein (recombinant), per IUNew Hampshire Precertification List, Pg 242 Original policy
J7207Injection, Factor VIII, (antihemophilic factor, recombinant), PEGylated, 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7208Injection, Factor VIII, (antihemophilic factor, recombinant), PEGylated-aucl, (Jivi), 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7209Injection, Factor VIII, (antihemophilic factor, recombinant), (Nuwiq), 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7210Injection, Factor VIII, (antihemophilic factor, recombinant), (Afstyla), 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7211Injection, Factor VIII, (antihemophilic factor, recombinant), (Kovaltry), 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7212Factor VIIa (antihemophilic factor, recombinant)-jncw (Sevenfact), 1 mcgNew Hampshire Precertification List, Pg 242 Original policy
J7213Injection, coagulation factor IX (recombinant), Ixinity, 1 IUNew Hampshire Precertification List, Pg 242 Original policy
J7214Injection, Factor VIII/von Willebrand factor complex, recombinant (Altuviiio), per Factor VIII IUNew Hampshire Precertification List, Pg 242 Original policy
J7311Injection, fluocinolone acetonide, intravitreal implant (Retisert), 0.01 mgNew Hampshire Precertification List, Pg 242 Original policy
J7312Injection, dexamethasone, intravitreal implant, 0.1 mgNew Hampshire Precertification List, Pg 242 Original policy
J7313Injection, fluocinolone acetonide, intravitreal implant (Iluvien), 0.01 mgNew Hampshire Precertification List, Pg 242 Original policy
J7314Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mgNew Hampshire Precertification List, Pg 242 Original policy
J7330Autologous cultured chondrocytes, implantNew Hampshire Precertification List, Pg 242 Original policy
J7340Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 mlNew Hampshire Precertification List, Pg 242 Original policy
J7351Injection, bimatoprost, intracameral implant, 1 mcgNew Hampshire Precertification List, Pg 242 Original policy
J7352Afamelanotide implant, 1 mgNew Hampshire Precertification List, Pg 242 Original policy
J7353Anacaulase-bcdb, 8.8% gel, 1 gmNew Hampshire Precertification List, Pg 242 Original policy
J7354Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)New Hampshire Precertification List, Pg 242 Original policy
J7355Injection, travoprost, intracameral implant, 1 mcgNew Hampshire Precertification List, Pg 243 Original policy
J7402Mometasone furoate sinus implant, (Sinuva), 10 mcgNew Hampshire Precertification List, Pg 243 Original policy
J7686Treprostinil, inhalation solution, FDA- approved final product, noncompounded, administered through DME, unit dose form, 1.74 mgNew Hampshire Precertification List, Pg 243 Original policy
J9015Injection, aldesleukin, per single use vialNew Hampshire Precertification List, Pg 243 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

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