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Anthem Blue Cross Blue Shield of California prior authorization, page 11

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
E0652Pneumatic compressor, segmental home model with calibrated gradient pressureCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0655Non-segmental pneumatic appliance for use with pneumatic compressor, half armCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0656Segmental pneumatic appliance for use with pneumatic compressor, trunkCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0657Segmental pneumatic appliance for use with pneumatic compressor, chestCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0658Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chestCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0659Segmental pneumatic appliance for use with pneumatic compressor, integrated, head, neck and chestCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0660Non-segmental pneumatic appliance for use with pneumatic compressor, full legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0665Non-segmental pneumatic appliance for use with pneumatic compressor, full armCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0666Non-segmental pneumatic appliance for use with pneumatic compressor, half legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0667Segmental pneumatic appliance for use with pneumatic compressor, full legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0668Segmental pneumatic appliance for use with pneumatic compressor, full armCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0669Segmental pneumatic appliance for use with pneumatic compressor, helf legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0670Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunkCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0671Segmental gradient pressure pneumatic appliance, full legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0672Segmental gradient pressure pneumatic appliance, full armCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0673Segmental gradient pressure pneumatic appliance, half legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0676Intermittent limb compression device (includes all accessories), not otherwise specifiedCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0677Non-pneumatic sequential compression garment, trunkCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0678Non-pneumatic sequential compression garment, full legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0679Non-pneumatic sequential compression garment, half legCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0680Non-pneumatic compression controller with sequential calibrated gradient pressureCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0681Non-pneumatic compression controller without calibrated gradient pressureCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0682Non-pneumatic sequential compression garment, full armCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0683Non-pneumatic, non-sequential, peristaltic wave compression pumpCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0734External upper limb tremor stimulator of the peripheral nerves of the wristCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0738Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, include microprocessor, all components and accessoriesCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0739Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensorsCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0745Neuromuscular stimulator, electronic shock unitCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0746Electromyography (EMG), biofeedback device [when specified as a home biofeedback device other than the SPEAC sEMG activity alert system for seizures which is addressed elsewhere] or [when specified as the SPEAC system]California PPO Prior Authorization List, Pg 23 Original policy
E0760Osteogenesis stimulator, low intensity ultrasound, noninvasiveCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0761Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment deviceCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0762Transcutaneous electrical joint stimulation device system, includes all accessories (PES)California PPO Prior Authorization List, Pg 23 Original policy
E0764Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training programCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0765FDA approved nerve stimulator, for treatment of nausea and vomiting [e.g., Reliefband® neuromodulation stimulator]California PPO Prior Authorization List, Pg 23 Original policy
E0769Electrical stimulation or electromagnetic wound treatment device, not otherwise classifiedCalifornia PPO Prior Authorization List, Pg 23 Original policy
E0770Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specifiedCalifornia PPO Prior Authorization List, Pg 24 Original policy
E0782Infusion pump, implantable, nonprogrammable (includes all components, e.g., pump, catheter, connectors, etc.)California PPO Prior Authorization List, Pg 24 Original policy
E0783Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)California PPO Prior Authorization List, Pg 24 Original policy
E0786Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)California PPO Prior Authorization List, Pg 24 Original policy
E0986Manual wheelchair accessory, power assist system (e.g. push- rim activated system)California PPO Prior Authorization List, Pg 24 Original policy
E1002Wheelchair accessory, power seating system, tilt onlyCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1003Wheelchair accessory, power seating system, recline only, without shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1004Wheelchair accessory, power seating system, recline only, with mechanical shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1005Wheelchair accessory, power seatng System, recline only, with power shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1006Wheelchair accessory, power seating system, combination tilt and recline, without shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1007Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1008Wheelchair accessory, power seating system, combination tilt and recline, with power shear reductionCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1009Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and legrest, eachCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1010Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pairCalifornia PPO Prior Authorization List, Pg 24 Original policy
E1012Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, eachCalifornia PPO Prior Authorization List, Pg 24 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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