Anthem Blue Cross and Blue Shield New Hampshire prior authorization, page 74

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
Code	Description	Source
S9562	Home injectable therapy, palivizumab or other monoclonal antibody for RSV, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem	New Hampshire Precertification List, Pg 272 Original policy
S9960	Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)	New Hampshire Precertification List, Pg 272 Original policy
S9961	Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)	New Hampshire Precertification List, Pg 272 Original policy
T2036	Therapeutic camping, overnight, waiver; each session	New Hampshire Precertification List, Pg 272 Original policy
T2037	Therapeutic camping, day, waiver; each session	New Hampshire Precertification List, Pg 272 Original policy
V2787	Astigmatism correcting function of intraocular lens	New Hampshire Precertification List, Pg 272 Original policy
V2788	Presbyopia correcting function of intraocular lens	New Hampshire Precertification List, Pg 272 Original policy
V2790	Amniotic membrane for surgical reconstruction, per procedure	New Hampshire Precertification List, Pg 272 Original policy
V5095	Semi-implantable middle ear hearing prosthesis	New Hampshire Precertification List, Pg 272 Original policy
V5298	Hearing aid, not otherwise classified	New Hampshire Precertification List, Pg 272 Original policy
V5362	Speech screening	New Hampshire Precertification List, Pg 272 Original policy
V5363	Language screening	New Hampshire Precertification List, Pg 272 Original policy
V5364	Dysphagia screening	New Hampshire Precertification List, Pg 272 Original policy

Sources

New Hampshire Precertification List

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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