Anthem Blue Cross Blue Shield of California prior authorization, page 69
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 |
|---|---|---|
| J7209 | Factor VIII, (antihemophilic factor, recombinant) (Nuwiq) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7210 | Factor VIII, (Antihemophilic Factor, recombinant) (Afstyla) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7211 | Factor VIII, (antihemophilic factor, recombinant( (Kovaltry) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7212 | Factor VIIa Recombinant (SevenFact) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7213 | Factor IX (anti-hemophilic factor, recombinant) (Ixinity) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7214 | Antihemophilic factor (recombinant) (Altuviiio) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7311 | Fluocinolone acetonide, intravitreal implant (Retisert) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7312 | Dexamethasone intravitreal implant (Ozurdex) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7313 | Fluocinolone acetonide intravitreal implant (Iluvien) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7314 | Fluocinolone acetonide, intravitreal implant (Yutiq) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7340 | Carbidopa/levodopa enteral suspension (Duopa) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7351 | Bimatoprost, intracameral implant (Durysta) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7352 | Afamelanotide (Scenesse) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7353 | Anacaulase-bcdb (Nexobrid) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7354 | Cantharidin (Ycanth) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7355 | Travoprost Implant (iDoseTR) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7356 | Ffoscarbidopa (Vyalev) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7686 | Treprostinil (Tyvaso) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7799 | Pegcetacoplan (Empaveli) | California PPO Prior Authorization List, Pg 185 Original policy |
| J7999 | Compounded drug, not otherwise classified [when specified as implantable naltrexone pellets] | California PPO Prior Authorization List, Pg 185 Original policy |
| J8499 | Treprostinil (Yutrepia) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9202 | Goserelin acetate (Zoladex) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9210 | Emapalumab-lzsg (Gamifant) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9217 | Leuprolide acetate (for depot suspension) (Lupron Depot) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9218 | Leuprolide acetate (Lupron) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9226 | Histrelin acetate (Supprelin LA) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9256 | Nipocalimab (Imaavy) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9312 | Rituximab (Rituxan) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9332 | Efgartigimod alfa-fcab (Vyvgart) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9333 | Rozanolixizumab-noli (Rystiggo) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9334 | Efgartigimod alfa and hyaluronidase-qvfc (Vyvgart Hytrulo) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9376 | Pozelimab-bbfg (Veopoz) | California PPO Prior Authorization List, Pg 186 Original policy |
| J9381 | Teplizumab-mzwv (Tzield) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q3027 | Interferon beta-1a (Avonex) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q3028 | Interferon beta-1a (Rebif) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q4074 | Iloprost (Ventavis) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5098 | Ustekinumab-srlf (Imuldosa) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5099 | Ustekinumab‑stba (Steqeyma) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5100 | Ustekinumab-kfce (Yesintek) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5103 | Infliximab-dyyb (Inflectra) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5104 | Infliximab-abda (Renflexis) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5121 | Infliximab-axxq (Avsola) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5123 | Rituximab-arrx (RIABNI) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5124 | Ranibizumab-nuna (Byooviz) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5128 | Ranibuzumab-cqrn (Cimerli) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5137 | Ustekinumab-auub (Wezlana) | California PPO Prior Authorization List, Pg 186 Original policy |
| Q5138 | Ustekinumab-auub (Wezlana) | California PPO Prior Authorization List, Pg 187 Original policy |
| Q5140 | Adalimumab-fkjp (Hulio) | California PPO Prior Authorization List, Pg 187 Original policy |
| Q5141 | Adalimumab-aaty (Yuflyma) | California PPO Prior Authorization List, Pg 187 Original policy |
| Q5142 | Adalimumab-ryvk (Simlandi) | California PPO Prior Authorization List, Pg 187 Original policy |