Anthem Blue Cross Blue Shield of California prior authorization, page 67
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
| Code | Description | Source |
|---|---|---|
| J1552 | Immune globulin, IV, nonlyophilized (Alyglo) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1577 | Immune globulin intravenous, human-kthm (Qivigy) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1595 | Glatiramer acetate (Copaxone) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1602 | Golimumab (Simponi Aria) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1628 | Guselkumab (Tremfya) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1632 | Brexanolone (Zulresso) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1675 | Histrelin acetate (Supprelin LA, Vantas) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1743 | Idursulfase (Elaprase) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1744 | Icatibant (Firazyr, Sajazir) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1745 | Infliximab (Remicade) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1747 | Spesolimab-sbzo (Spevigo) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1748 | Infliximab-dyyb (Zymfentra) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1757 | Tividenofusp alfa-eknm) (Avlayah) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1786 | Imiglucerase (Cerezyme) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1809 | Fosdenopterin (Nulibry) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1818 | Pegzilarginase-nbln (Loargys) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1823 | Inebilizumab-cdon (Uplizna) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1826 | Interferon beta-1a (Avonex) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1830 | Interferon beta-1b (Betaseron) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1931 | Laronidase (Aldurazyme) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1950 | Leuprolide acetate (for depot suspension) (Lupron Depot-Ped) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1951 | Leuprolide acetate (Fensolvi) | California PPO Prior Authorization List, Pg 179 Original policy |
| J1954 | Leuprolide acetate (for depot suspension) (Lupron Depot) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2170 | Mecasermin (Increlex) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2182 | Mepolizumab (Nucala) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2267 | Mirikizumab-mrkz (Omvoh) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2278 | Ziconotide Intrathecal Infusion (Prialt) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2323 | Natalizumab (Tysabri) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2326 | Nusinersen (Spinraza) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2327 | Risankizumab-rzaa (Skyrizi) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2329 | Ublituximab (Briumvi) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2350 | Ocrelizumab (Ocrevus) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2351 | Ocrelizumab/hyaluronidase-ocsq (Ocrevus Zunovo) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2356 | Tezepelumab-ekko (Tezspire) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2357 | Omalizumab (Xolair) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2361 | Depemokimab-ulaa (Exdensur) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2502 | Pasireotide (Signifor LAR) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2507 | Pegloticase (Krystexxa) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2508 | Pegunigalsidase alfa-iwxj (Elfabrio) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2777 | Faricimab-svoa (Vabysmo) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2778 | Ranibizumab (Lucentis) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2781 | Pegcetacoplan (Syfovre) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2782 | Avacincaptad pegol (Izervay) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2786 | Reslizumab (Cinqair) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2793 | Rilonacept (Arcalyst) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2840 | Sebelipase alfa (Kanuma) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2941 | Somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Zomacton) | California PPO Prior Authorization List, Pg 180 Original policy |
| J2998 | Plasminogen, human-tvmh (Ryplazim) | California PPO Prior Authorization List, Pg 180 Original policy |
| J3032 | Eptinezumab (Vyepti) | California PPO Prior Authorization List, Pg 181 Original policy |
| J3060 | Taliglucerase alfa (Elelyso) | California PPO Prior Authorization List, Pg 181 Original policy |