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Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 63

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
J9348Injection, naxitamab-gqgk, 1 mNew Hampshire Precertification List, Pg 246 Original policy
J9349Injection, tafasitamab-cxix, 2 mgNew Hampshire Precertification List, Pg 246 Original policy
J9350Injection, mosunetuzumab-axgb, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9353Injection, margetuximab-cmkb, 5 mNew Hampshire Precertification List, Pg 246 Original policy
J9354Injection, ado-trastuzumab emtansine, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9358Injection, fam-trastuzumab deruxtecan- nxki, 1 mgNew Hampshire Precertification List, Pg 246 Original policy
J9359Injection, loncastuximab tesirine-lpyl, 0.075 mgNew Hampshire Precertification List, Pg 247 Original policy
J9361Injection, efbemalenograstim alfa-vuxw, 0.5 mgNew Hampshire Precertification List, Pg 247 Original policy
J9376Injection, pozelimab-bbfg, 1 mgNew Hampshire Precertification List, Pg 247 Original policy
J9380Injection, teclistamab-cqyv, 0.5 mgNew Hampshire Precertification List, Pg 247 Original policy
J9381Injection, teplizumab-mzwv, 5 mcgNew Hampshire Precertification List, Pg 247 Original policy
J9382Injection, zenocutuzumab-zbco, 1 mgNew Hampshire Precertification List, Pg 247 Original policy
J9393Injection, fulvestrant (Teva), not therapeutically equivalent to J9395, 25 mgNew Hampshire Precertification List, Pg 247 Original policy
J9394Injection, fulvestrant (Fresenius Kabi) not therapeutically equivalent to J9395, 25 mgNew Hampshire Precertification List, Pg 247 Original policy
J9395Injection, fulvestrant, 25 mgNew Hampshire Precertification List, Pg 247 Original policy
J9400Injection, ziv-aflibercept, 1 mgNew Hampshire Precertification List, Pg 247 Original policy
J9601Injection, linvoseltamab-gcpt, 1 mgNew Hampshire Precertification List, Pg 247 Original policy
J9999Not otherwise classified, antineoplastic drugsNew Hampshire Precertification List, Pg 247 Original policy
K0010Standard-weight frame motorized/power wheelchairNew Hampshire Precertification List, Pg 247 Original policy
K0011Standard-weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and brakingNew Hampshire Precertification List, Pg 247 Original policy
K0012Lightweight portable motorized/power wheelchairNew Hampshire Precertification List, Pg 247 Original policy
K0013Custom motorized/power wheelchair baseNew Hampshire Precertification List, Pg 247 Original policy
K0014Other motorized/power wheelchair baseNew Hampshire Precertification List, Pg 247 Original policy
K0455Infusion pump used for uninterrupted parenteral administration of medication, (e.g., epoprostenol or treprostinol)New Hampshire Precertification List, Pg 247 Original policy
K0606Automatic external defibrillator, with integrated electrocardiogram analysis, garment typeNew Hampshire Precertification List, Pg 247 Original policy
K0800Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 247 Original policy
K0801Power operated vehicle, group 1 heavy- duty, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 247 Original policy
K0802Power operated vehicle, group 1 very heavy-duty, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 247 Original policy
K0806Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 247 Original policy
K0807Power operated vehicle, group 2 heavy- duty, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0808Power operated vehicle, group 2 very heavy-duty, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0812Power operated vehicle, not otherwise classifiedNew Hampshire Precertification List, Pg 248 Original policy
K0813Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0814Power wheelchair, group 1 standard, portable, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0815Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0816Power wheelchair, group 1 standard, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0820Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0821Power wheelchair, group 2 standard, portable, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0822Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0823Power wheelchair, group 2 standard, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0824Power wheelchair, group 2 heavy-duty, sling/solid seat/back, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0825Power wheelchair, group 2 heavy-duty, captain's chair, patient weight capacity 301 to 450 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0826Power wheelchair, group 2 very heavy- duty, sling/solid seat/back, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0827Power wheelchair, group 2 very heavy- duty, captain's chair, patient weight capacity 451 to 600 poundsNew Hampshire Precertification List, Pg 248 Original policy
K0828Power wheelchair, group 2 extra heavy- duty, sling/solid seat/back, patient weight capacity 601 pounds or moreNew Hampshire Precertification List, Pg 248 Original policy
K0829Power wheelchair, group 2 extra heavy- duty, captain's chair, patient weight 601 pounds or moreNew Hampshire Precertification List, Pg 248 Original policy
K0830Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0831Power wheelchair, group 2 standard, seat elevator, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0835Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 Original policy
K0836Power wheelchair, group 2 standard, single power option, captain's chair, patient weight capacity up to and including 300 poundsNew Hampshire Precertification List, Pg 249 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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