Anthem Blue Cross Blue Shield of Colorado prior authorization, page 13
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 |
|---|---|---|
| 29885 | Arthroscopy, Knee, Surgical; Drill, Osteochondritis Dissecans W/Bone Graft, W/Wo Int/Ext Fixation | Colorado Prior Authorization List, Pg 33 Original policy |
| 29886 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion | Colorado Prior Authorization List, Pg 34 Original policy |
| 29887 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion W/Int Fixation | Colorado Prior Authorization List, Pg 34 Original policy |
| 29888 | Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation/Reconstruction | Colorado Prior Authorization List, Pg 34 Original policy |
| 29889 | Arthroscopically Aided Posterior Cruciate Ligament Repair/Augmentation/Reconstruction | Colorado Prior Authorization List, Pg 34 Original policy |
| 29892 | Arthroscopically Aided Repair, Osteochondritis/Talar Dome Fx/Tibial Plafond Fx | Colorado Prior Authorization List, Pg 34 Original policy |
| 29914 | Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion) | Colorado Prior Authorization List, Pg 34 Original policy |
| 29915 | Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment of pincer lesion) | Colorado Prior Authorization List, Pg 34 Original policy |
| 29916 | Arthroscopy, hip, surgical; with labral repair | Colorado Prior Authorization List, Pg 34 Original policy |
| 30100 | Bx, Intranasal | Colorado Prior Authorization List, Pg 34 Original policy |
| 30115 | Excision, Nasal Polyp(S), Extensive | Colorado Prior Authorization List, Pg 34 Original policy |
| 30117 | Excision/Destruction, Intranasal Lesion; Int Approach | Colorado Prior Authorization List, Pg 34 Original policy |
| 30118 | Excision/Destruction, Intranasal Lesion; Ext Approach | Colorado Prior Authorization List, Pg 34 Original policy |
| 30120 | Excision/Surgical Planing, Skin, Nose, Rhinophyma | Colorado Prior Authorization List, Pg 34 Original policy |
| 30130 | Excision inferior turbinate, partial or complete, any method | Colorado Prior Authorization List, Pg 34 Original policy |
| 30140 | Submucous resection inferior turbinate, partial or complete, any method | Colorado Prior Authorization List, Pg 34 Original policy |
| 30220 | Insertion, Nasal Septal Prosthesis (Button) | Colorado Prior Authorization List, Pg 34 Original policy |
| 30310 | Removal Fb, Intranasal; Requiring General Anesthesia | Colorado Prior Authorization List, Pg 34 Original policy |
| 30400 | Rhinoplasty, Primary; Lateral & Alar Cartilages &/Or Elevation, Nasal Tip | Colorado Prior Authorization List, Pg 35 Original policy |
| 30410 | Rhinoplasty, Primary; Complete, Ext Parts W/Bony Pyramid, Lat & Alar Cartilages &/Or Elev Nasal Tip | Colorado Prior Authorization List, Pg 35 Original policy |
| 30420 | Rhinoplasty, Primary; W/Major Septal Repair | Colorado Prior Authorization List, Pg 35 Original policy |
| 30430 | Rhinoplasty, Secondary; Minor Revision (Small Amount, Nasal Tip Work) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30435 | Rhinoplasty, Secondary; Intermediate Revision (Bony Work W/Osteotomies) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30450 | Rhinoplasty, Secondary; Major Revision (Nasal Tip Work & Osteotomies) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30468 | Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30469 | Repair of nasal valve collapse with low energy, temperature-controlled (ie, radiofrequency) subcutaneous/submucosal | Colorado Prior Authorization List, Pg 35 Original policy |
| 30520 | Septoplasty/Submucous Resection W/Wo Cartilage Scoring/Contouring/Graft | Colorado Prior Authorization List, Pg 35 Original policy |
| 30580 | Repair Fistula; Oromaxillary (Combine W/31030 If Antrotomy Is Included) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30620 | Septal/Other Intranasal Dermatoplasty (Does Not Include Obtaining Graft) | Colorado Prior Authorization List, Pg 35 Original policy |
| 30630 | Repair Nasal Septal Perforations | Colorado Prior Authorization List, Pg 35 Original policy |
| 30801 | Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ab | Colorado Prior Authorization List, Pg 35 Original policy |
| 30802 | Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ab | Colorado Prior Authorization List, Pg 35 Original policy |
| 30901 | Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery &/Or Packing) Any Method | Colorado Prior Authorization List, Pg 35 Original policy |
| 30903 | Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery &/Or Packing) Any Method | Colorado Prior Authorization List, Pg 35 Original policy |
| 30930 | Fracture nasal inferior turbinate(s), therapeutic | Colorado Prior Authorization List, Pg 35 Original policy |
| 31020 | Sinusotomy, Maxillary (Antrotomy); Intranasal | Colorado Prior Authorization List, Pg 35 Original policy |
| 31030 | Sinusotomy, Maxillary (Antrotomy); Radical (Caldwell-Luc) W/O Removal, Antrochoanal Polyps | Colorado Prior Authorization List, Pg 35 Original policy |
| 31032 | Sinusotomy, Maxillary (Antrotomy); Radical (Caldwell-Luc) W/Removal, Antrochoanal Polyps | Colorado Prior Authorization List, Pg 35 Original policy |
| 31200 | Ethmoidectomy; Intranasal, Anterior | Colorado Prior Authorization List, Pg 35 Original policy |
| 31237 | Nasal/Sinus Endoscopy, Surgical; W/Bx, Polypectomy/Debridement (Sep Proc) | Colorado Prior Authorization List, Pg 35 Original policy |
| 31238 | Nasal/Sinus Endoscopy, Surgical; W/Control, Nasal Hemorrhage | Colorado Prior Authorization List, Pg 35 Original policy |
| 31242 | Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve | Colorado Prior Authorization List, Pg 35 Original policy |
| 31243 | Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve | Colorado Prior Authorization List, Pg 35 Original policy |
| 31253 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when perfor | Colorado Prior Authorization List, Pg 35 Original policy |
| 31254 | Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) | Colorado Prior Authorization List, Pg 36 Original policy |
| 31255 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) | Colorado Prior Authorization List, Pg 36 Original policy |
| 31256 | Nasal/Sinus Endoscopy, Surgical, W/Maxillary Antrostomy | Colorado Prior Authorization List, Pg 36 Original policy |
| 31257 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy | Colorado Prior Authorization List, Pg 36 Original policy |
| 31259 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus | Colorado Prior Authorization List, Pg 36 Original policy |
| 31267 | Nasal/Sinus Endoscopy, Surgical, W/Maxillary Antrostomy; W/Maxillary Tissue Removal | Colorado Prior Authorization List, Pg 36 Original policy |