Talk to Us

Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 61

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
J9019Injection, asparaginase (Erwinaze), 1,000 IUNew Hampshire Precertification List, Pg 243 Original policy
J9021Injection, asparaginase, recombinant, (Rylaze), 0.1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9022Injection, atezolizumab, 10 mgNew Hampshire Precertification List, Pg 243 Original policy
J9023Injection, avelumab, 10 mgNew Hampshire Precertification List, Pg 243 Original policy
J9024Injection, atezolizumab, 5 mg and hyaluronidase-tqjsNew Hampshire Precertification List, Pg 243 Original policy
J9026Injection, tarlatamab-dlle, 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9028Injection, nogapendekin alfa inbakicept- pmln, for intravesical use, 1 mcgNew Hampshire Precertification List, Pg 243 Original policy
J9029Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic doseNew Hampshire Precertification List, Pg 243 Original policy
J9032Injection, belinostat, 10 mgNew Hampshire Precertification List, Pg 243 Original policy
J9033Injection, bendamustine HCl (Treanda), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9034Injection, bendamustine HCl (Bendeka), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9035Injection, bevacizumab, 10 mgNew Hampshire Precertification List, Pg 243 Original policy
J9036Injection, bendamustine HCl, (Belrapzo/bendamustine), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9038Injection, axatilimab-csfr, 0.1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9039Injection, blinatumomab, 1 mcgNew Hampshire Precertification List, Pg 243 Original policy
J9042Injection, brentuximab vedotin, 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9043Injection, cabazitaxel, 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9047Injection, carfilzomib, 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9055Injection, cetuximab, 10 mgNew Hampshire Precertification List, Pg 243 Original policy
J9056Injection, bendamustine HCl (Vivimusta), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9057Injection, copanlisib, 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9058Injection, bendamustine HCl (Apotex), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9059Injection, bendamustine HCl (Baxter), 1 mgNew Hampshire Precertification List, Pg 243 Original policy
J9061Injection, amivantamab-vmjw, 2 mgNew Hampshire Precertification List, Pg 244 Original policy
J9063Injection, mirvetuximab soravtansine- gynx, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9064Injection, cabazitaxel (Sandoz), not therapeutically equivalent to J9043, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9118Injection, calaspargase pegol-mknl, 10 unitsNew Hampshire Precertification List, Pg 244 Original policy
J9119Injection, cemiplimab-rwlc, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9144Injection, daratumumab, 10 mg and hyaluronidase-fihjNew Hampshire Precertification List, Pg 244 Original policy
J9145Injection, daratumumab, 10 mgNew Hampshire Precertification List, Pg 244 Original policy
J9161Injection, denileukin diftitox-cxdl, 1 mcgNew Hampshire Precertification List, Pg 244 Original policy
J9173Injection, durvalumab, 10 mgNew Hampshire Precertification List, Pg 244 Original policy
J9176Injection, elotuzumab, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9177Injection, enfortumab vedotin-ejfv, 0.25 mgNew Hampshire Precertification List, Pg 244 Original policy
J9179Injection, eribulin mesylate, 0.1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9183Gemcitabine intravesical system, 225 mgNew Hampshire Precertification List, Pg 244 Original policy
J9202Goserelin acetate implant, per 3.6 mgNew Hampshire Precertification List, Pg 244 Original policy
J9203Injection, gemtuzumab ozogamicin, 0.1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9207Injection, ixabepilone, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9210Injection, emapalumab-lzsg, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9216Injection, interferon, gamma-1B, 3 million unitsNew Hampshire Precertification List, Pg 244 Original policy
J9217Leuprolide acetate (for depot suspension), 7.5 mgNew Hampshire Precertification List, Pg 244 Original policy
J9223Injection, lurbinectedin, 0.1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9225Histrelin implant (Vantas), 50 mgNew Hampshire Precertification List, Pg 244 Original policy
J9226Histrelin implant (Supprelin LA), 50 mgNew Hampshire Precertification List, Pg 244 Original policy
J9227Injection, isatuximab-irfc, 10 mgNew Hampshire Precertification List, Pg 244 Original policy
J9228Injection, ipilimumab, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9229Injection, inotuzumab ozogamicin, 0.1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9248Injection, melphalan (Hepzato), 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9256Injection, nipocalimab-aahu, 3 mgNew Hampshire Precertification List, Pg 244 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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

This website uses cookies to ensure you get the best experience on our website. Learn more