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Anthem Blue Cross Blue Shield of California prior authorization, page 38

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
27425Release of ligaments of knee joint, open procedureCalifornia PPO Prior Authorization List, Pg 88 Original policy
27427Ligamentous reconstruction (augmentation), knee; extra- articularCalifornia PPO Prior Authorization List, Pg 88 Original policy
27428Ligamentous reconstruction (augmentation), knee; intra- articular (open)California PPO Prior Authorization List, Pg 88 Original policy
27429Ligamentous reconstruction (augmentation), knee; intra- articular (open) and extra-articularCalifornia PPO Prior Authorization List, Pg 88 Original policy
27437Arthroplasty, patella; without prosthesisCalifornia PPO Prior Authorization List, Pg 88 Original policy
27438Arthroplasty, patella; with prosthesisCalifornia PPO Prior Authorization List, Pg 88 Original policy
27440Arthroplasty, knee; tibial plateauCalifornia PPO Prior Authorization List, Pg 88 Original policy
27441Arthroplasty, knee, tibial plateau; with debridement and partial synovectomyCalifornia PPO Prior Authorization List, Pg 88 Original policy
27442Arthroplasty, femoral condyles or tibial plateau(s), kneeCalifornia PPO Prior Authorization List, Pg 88 Original policy
27446Arthroplasty, knee, condyle and plateau; medial OR lateral compartmentCalifornia PPO Prior Authorization List, Pg 88 Original policy
27447Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)California PPO Prior Authorization List, Pg 88 Original policy
27486Revision of total knee arthroplasty, with or without allograft; 1 componentCalifornia PPO Prior Authorization List, Pg 88 Original policy
27487Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial componentCalifornia PPO Prior Authorization List, Pg 88 Original policy
27488Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, kneeCalifornia PPO Prior Authorization List, Pg 88 Original policy
27570Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)California PPO Prior Authorization List, Pg 88 Original policy
27702Arthroplasty, Ankle; W/Implant (Total Ankle)California PPO Prior Authorization List, Pg 88 Original policy
27703Arthroplasty, Ankle; Revision, Total AnkleCalifornia PPO Prior Authorization List, Pg 88 Original policy
27704Removal, Ankle ImplantCalifornia PPO Prior Authorization List, Pg 88 Original policy
27870Arthrodesis, Ankle, OpenCalifornia PPO Prior Authorization List, Pg 88 Original policy
28110Ostectomy, Partial Excision, 5th Metatarsal Head (Bunionette)California PPO Prior Authorization List, Pg 89 Original policy
28285Correction, HammertoeCalifornia PPO Prior Authorization List, Pg 89 Original policy
28286Correction, Cock-Up Fifth Toe, W/Plastic Skin ClosureCalifornia PPO Prior Authorization List, Pg 89 Original policy
28289Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implantCalifornia PPO Prior Authorization List, Pg 89 Original policy
28291Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint with implantCalifornia PPO Prior Authorization List, Pg 89 Original policy
28292Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any methodCalifornia PPO Prior Authorization List, Pg 89 Original policy
28295Correction, hallux valgus (bunion), with or without sesamoidectomy;with proximal metatarsal osteotomy, any methodCalifornia PPO Prior Authorization List, Pg 89 Original policy
28296Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any methodCalifornia PPO Prior Authorization List, Pg 89 Original policy
28297Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus-type procedureCalifornia PPO Prior Authorization List, Pg 89 Original policy
28298Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any methodCalifornia PPO Prior Authorization List, Pg 89 Original policy
28299Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any methodCalifornia PPO Prior Authorization List, Pg 89 Original policy
28306Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsalCalifornia PPO Prior Authorization List, Pg 89 Original policy
28307Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe)California PPO Prior Authorization List, Pg 89 Original policy
28308Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, eachCalifornia PPO Prior Authorization List, Pg 89 Original policy
28310Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)California PPO Prior Authorization List, Pg 89 Original policy
28312Osteotomy, shortening, angular or rotational correction; other phalanges, any toeCalifornia PPO Prior Authorization List, Pg 89 Original policy
28315Sesamoidectomy, first toe (separate procedure)California PPO Prior Authorization List, Pg 89 Original policy
28446Open osteochondral autograft, talus (includes obtaining graft[s])California PPO Prior Authorization List, Pg 89 Original policy
28750Arthrodesis, Great Toe; Metatarsophalangeal JointCalifornia PPO Prior Authorization List, Pg 89 Original policy
29800Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)California PPO Prior Authorization List, Pg 90 Original policy
29804Arthroscopy, temporomandibular joint, surgicalCalifornia PPO Prior Authorization List, Pg 90 Original policy
29805Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)California PPO Prior Authorization List, Pg 90 Original policy
29806Arthroscopy, shoulder, surgical; capsulorrhaphyCalifornia PPO Prior Authorization List, Pg 90 Original policy
29807Arthroscopy, shoulder, surgical; repair of SLAP lesionCalifornia PPO Prior Authorization List, Pg 90 Original policy
29819Arthroscopy, shoulder, surgical; with removal of loose body or foreign bodyCalifornia PPO Prior Authorization List, Pg 90 Original policy
29820Arthroscopy, shoulder, surgical; synovectomy, partialCalifornia PPO Prior Authorization List, Pg 90 Original policy
29821Arthroscopy, shoulder, surgical; synovectomy, completeCalifornia PPO Prior Authorization List, Pg 90 Original policy
29822Arthroscopy, shoulder, surgical; debridement, limitedCalifornia PPO Prior Authorization List, Pg 90 Original policy
29823Arthroscopy, shoulder, surgical; debridement, extensiveCalifornia PPO Prior Authorization List, Pg 90 Original policy
29824Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)California PPO Prior Authorization List, Pg 90 Original policy
29825Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulationCalifornia PPO Prior Authorization List, Pg 90 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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