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Anthem Blue Cross Blue Shield of California prior authorization, page 37

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
22860Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar (List separately in addition to code for primary procedure)California PPO Prior Authorization List, Pg 85 Original policy
22861Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervicalCalifornia PPO Prior Authorization List, Pg 85 Original policy
22862Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbarCalifornia PPO Prior Authorization List, Pg 85 Original policy
22864Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervicalCalifornia PPO Prior Authorization List, Pg 85 Original policy
22865Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbarCalifornia PPO Prior Authorization List, Pg 85 Original policy
23105Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsyCalifornia PPO Prior Authorization List, Pg 85 Original policy
23107Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign bodyCalifornia PPO Prior Authorization List, Pg 85 Original policy
23120Claviculectomy; partialCalifornia PPO Prior Authorization List, Pg 85 Original policy
23130Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament releaseCalifornia PPO Prior Authorization List, Pg 85 Original policy
23410Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acuteCalifornia PPO Prior Authorization List, Pg 85 Original policy
23412Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronicCalifornia PPO Prior Authorization List, Pg 85 Original policy
23415Coracoacromial ligament release, with or without acromioplastyCalifornia PPO Prior Authorization List, Pg 85 Original policy
23420Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)California PPO Prior Authorization List, Pg 86 Original policy
23430Tenodesis of long tendon of bicepsCalifornia PPO Prior Authorization List, Pg 86 Original policy
23440Resection or transplantation of long tendon of bicepsCalifornia PPO Prior Authorization List, Pg 86 Original policy
23450Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operationCalifornia PPO Prior Authorization List, Pg 86 Original policy
23455Capsulorrhaphy, anterior; with labral repair (e.g., Bankart procedure)California PPO Prior Authorization List, Pg 86 Original policy
23460Capsulorrhaphy, anterior, any type; with bone blockCalifornia PPO Prior Authorization List, Pg 86 Original policy
23462Capsulorrhaphy, anterior, any type; with coracoid process transferCalifornia PPO Prior Authorization List, Pg 86 Original policy
23465Capsulorrhaphy, glenohumeral joint, posterior, with or without bone blockCalifornia PPO Prior Authorization List, Pg 86 Original policy
23466Capsulorrhaphy, glenohumeral joint, any type multi-directional instabilityCalifornia PPO Prior Authorization List, Pg 86 Original policy
23470Arthroplasty, glenohumeral joint; hemiarthroplastyCalifornia PPO Prior Authorization List, Pg 86 Original policy
23472Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement [e.g., total shoulder])California PPO Prior Authorization List, Pg 86 Original policy
23473Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid componentCalifornia PPO Prior Authorization List, Pg 86 Original policy
23474Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid componentCalifornia PPO Prior Authorization List, Pg 86 Original policy
23700Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)California PPO Prior Authorization List, Pg 86 Original policy
27096Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performedCalifornia PPO Prior Authorization List, Pg 86 Original policy
27120Acetabuloplasty; (e.g., Whitman, Colonna, Haygroves, or cup type)California PPO Prior Authorization List, Pg 86 Original policy
27122Acetabuloplasty; resection, femoral head (e.g., Girdlestone procedure)California PPO Prior Authorization List, Pg 86 Original policy
27125Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty)California PPO Prior Authorization List, Pg 86 Original policy
27130Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograftCalifornia PPO Prior Authorization List, Pg 86 Original policy
27132Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograftCalifornia PPO Prior Authorization List, Pg 87 Original policy
27134Revision of total hip arthroplasty; both components, with or without autograft or allograftCalifornia PPO Prior Authorization List, Pg 87 Original policy
27137Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograftCalifornia PPO Prior Authorization List, Pg 87 Original policy
27138Revision of total hip arthroplasty; femoral component only, with or without allograftCalifornia PPO Prior Authorization List, Pg 87 Original policy
27279Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of transarticular device(s) and/or intra-articular device(s) piercing the lateral or medial cortices of the ilium and the lateral cortex of the sacrumCalifornia PPO Prior Authorization List, Pg 87 Original policy
27280Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performedCalifornia PPO Prior Authorization List, Pg 87 Original policy
27331Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodiesCalifornia PPO Prior Authorization List, Pg 87 Original policy
27332Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateralCalifornia PPO Prior Authorization List, Pg 87 Original policy
27333Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateralCalifornia PPO Prior Authorization List, Pg 87 Original policy
27334Arthrotomy, with synovectomy, knee; anterior OR posteriorCalifornia PPO Prior Authorization List, Pg 87 Original policy
27335Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal areaCalifornia PPO Prior Authorization List, Pg 87 Original policy
27345Excision synovial cyst popliteal spaceCalifornia PPO Prior Authorization List, Pg 87 Original policy
27403Arthrotomy with meniscus repair, kneeCalifornia PPO Prior Authorization List, Pg 87 Original policy
27405Repair, primary, torn ligament and/or capsule, knee; collateralCalifornia PPO Prior Authorization List, Pg 87 Original policy
27407Repair, primary, torn ligament and/or capsule, knee; cruciateCalifornia PPO Prior Authorization List, Pg 87 Original policy
27409Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligamentsCalifornia PPO Prior Authorization List, Pg 87 Original policy
27412Autologous chondrocyte implantation, kneeCalifornia PPO Prior Authorization List, Pg 87 Original policy
27415Osteochondral allograft, knee, openCalifornia PPO Prior Authorization List, Pg 87 Original policy
27416Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s])California PPO Prior Authorization List, Pg 87 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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