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Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 62

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
J9259Injection, paclitaxel protein-bound particles (American Regent), not therapeutically equivalent to J9264, 1 mgNew Hampshire Precertification List, Pg 244 Original policy
J9262Injection, omacetaxine mepesuccinate, 0.01 mgNew Hampshire Precertification List, Pg 245 Original policy
J9264Injection, paclitaxel protein-bound particles, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9266Injection, pegaspargase, per single dose vialNew Hampshire Precertification List, Pg 245 Original policy
J9269Injection, tagraxofusp-erzs, 10 mcgNew Hampshire Precertification List, Pg 245 Original policy
J9271Injection, pembrolizumab, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9272Injection, dostarlimab-gxly, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9273Injection, tisotumab vedotin-tftv, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9274Injection, tebentafusp-tebn, 1 mcgNew Hampshire Precertification List, Pg 245 Original policy
J9275Injection, cosibelimab-ipdl, 2 mgNew Hampshire Precertification List, Pg 245 Original policy
J9276Injection, zanidatamab-hrii, 2 mgNew Hampshire Precertification List, Pg 245 Original policy
J9277Injection, pembrolizumab, 1 mg and berahNew Hampshire Precertification List, Pg 245 Original policy
J9281Mitomycin pyelocalyceal instillation, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9282Mitomycin, intravesical instillation, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9286Injection, glofitamab-gxbm, 2.5 mgNew Hampshire Precertification List, Pg 245 Original policy
J9289Injection, nivolumab, 2 mg and hyaluronidase- nvhyNew Hampshire Precertification List, Pg 245 Original policy
J9292Injection, pemetrexed (Avyxa), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9294Injection, pemetrexed (Hospira), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9296Injection, pemetrexed (Accord), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9297Injection, pemetrexed (Sandoz), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9298Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9299Injection, nivolumab, 1 mgNew Hampshire Precertification List, Pg 245 Original policy
J9301Injection, obinutuzumab, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9302Injection, ofatumumab, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9303Injection, panitumumab, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9304Injection, pemetrexed (Pemfexy), 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9305Injection, pemetrexed, NOS, 10 mgNew Hampshire Precertification List, Pg 245 Original policy
J9306Injection, pertuzumab, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9308Injection, ramucirumab, 5 mgNew Hampshire Precertification List, Pg 246 Original policy
J9309Injection, polatuzumab vedotin-piiq, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9312Injection, rituximab, 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9313Injection, moxetumomab pasudotox-tdfk, 0.01 mgNew Hampshire Precertification List, Pg 246 Original policy
J9314Injection, pemetrexed (Teva), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9316Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9317Injection, sacituzumab govitecan-hziy, 2.5 mgNew Hampshire Precertification List, Pg 246 Original policy
J9318Injection, romidepsin, nonlyophilized, 0.1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9319Injection, romidepsin, lyophilized, 0.1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9321Injection, epcoritamab-bysp, 0.16 mgNew Hampshire Precertification List, Pg 246 Original policy
J9322Injection, pemetrexed (BluePoint), not therapeutically equivalent to J9305, 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9323Injection, pemetrexed ditromethamine, 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9324Injection, pemetrexed (Pemrydi RTU), 10 mgNew Hampshire Precertification List, Pg 246 Original policy
J9325Injection, talimogene laherparepvec, per 1 million plaque forming unitsNew Hampshire Precertification List, Pg 246 Original policy
J9326Injection, telisotuzumab vedotin-tllv, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9329Injection, tislelizumab-jsgr, 1mgNew Hampshire Precertification List, Pg 246 Original policy
J9331Injection, sirolimus protein-bound particles, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9332Injection, efgartigimod alfa-fcab, 2mgNew Hampshire Precertification List, Pg 246 Original policy
J9333Injection, rozanolixizumab-noli, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9334Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfcNew Hampshire Precertification List, Pg 246 Original policy
J9345Injection, retifanlimab-dlwr, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9347Injection, tremelimumab-actl, 1 mgNew Hampshire Precertification List, Pg 246 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.

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