Anthem Blue Cross Blue Shield of Colorado prior authorization, page 14
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 |
|---|---|---|
| 31276 | Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed | Colorado Prior Authorization List, Pg 36 Original policy |
| 31287 | Nasal/Sinus Endoscopy, Surgical, W/Sphenoidotomy | Colorado Prior Authorization List, Pg 36 Original policy |
| 31288 | Nasal/Sinus Endoscopy, Surgical, W/Sphenoidotomy; W/Tissue Removal, Sphenoid Sinus | Colorado Prior Authorization List, Pg 36 Original policy |
| 31295 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa | Colorado Prior Authorization List, Pg 36 Original policy |
| 31296 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium | Colorado Prior Authorization List, Pg 36 Original policy |
| 31297 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium | Colorado Prior Authorization List, Pg 36 Original policy |
| 31298 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia | Colorado Prior Authorization List, Pg 36 Original policy |
| 31525 | Laryngoscopy Direct, W/Wo Tracheoscopy; Dx, Except Newborn | Colorado Prior Authorization List, Pg 36 Original policy |
| 31526 | Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope | Colorado Prior Authorization List, Pg 36 Original policy |
| 31528 | Laryngoscopy Direct, W/Wo Tracheoscopy; W/Dilatation, Initial | Colorado Prior Authorization List, Pg 36 Original policy |
| 31529 | Laryngoscopy Direct, W/Wo Tracheoscopy; W/Dilatation, Subsequent | Colorado Prior Authorization List, Pg 36 Original policy |
| 31530 | Laryngoscopy, Direct, Operative, W/Fb Removal | Colorado Prior Authorization List, Pg 36 Original policy |
| 31535 | Laryngoscopy, Direct, Operative, W/Bx | Colorado Prior Authorization List, Pg 36 Original policy |
| 31536 | Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope | Colorado Prior Authorization List, Pg 36 Original policy |
| 31540 | Laryngoscopy, Direct, Operative, W/Excision, Tumor/Stripping Vocal Cords/Epiglottis | Colorado Prior Authorization List, Pg 36 Original policy |
| 31541 | Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating mi | Colorado Prior Authorization List, Pg 36 Original policy |
| 31545 | Laryngoscopy, Direct, W Operating Micro/Telescope, W Removal Vocal Cord Lesions; Reconstruction W Local Tissue | Colorado Prior Authorization List, Pg 36 Original policy |
| 31570 | Laryngoscopy, Direct, W/Injection Into Vocal Cord(S), Therapeutic | Colorado Prior Authorization List, Pg 36 Original policy |
| 31571 | Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope | Colorado Prior Authorization List, Pg 36 Original policy |
| 31574 | Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral | Colorado Prior Authorization List, Pg 36 Original policy |
| 31575 | Laryngoscopy, flexible; diagnostic | Colorado Prior Authorization List, Pg 36 Original policy |
| 31576 | Laryngoscopy, flexible; with biopsy(ies) | Colorado Prior Authorization List, Pg 36 Original policy |
| 31578 | Laryngoscopy, flexible; with removal of lesion(s), non-laser | Colorado Prior Authorization List, Pg 36 Original policy |
| 31591 | Laryngoplasty; medialization, unilateral | Colorado Prior Authorization List, Pg 36 Original policy |
| 31622 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when pe | Colorado Prior Authorization List, Pg 36 Original policy |
| 31623 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings | Colorado Prior Authorization List, Pg 37 Original policy |
| 31624 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage | Colorado Prior Authorization List, Pg 37 Original policy |
| 31625 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy | Colorado Prior Authorization List, Pg 37 Original policy |
| 31628 | Bronchoscopy, Rigid/Flexible; W/Transbronchial Lung Bx | Colorado Prior Authorization List, Pg 37 Original policy |
| 31643 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intr | Colorado Prior Authorization List, Pg 37 Original policy |
| 31652 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg | Colorado Prior Authorization List, Pg 37 Original policy |
| 31660 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe | Colorado Prior Authorization List, Pg 37 Original policy |
| 31661 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes | Colorado Prior Authorization List, Pg 37 Original policy |
| 31820 | Surgical Closure Tracheostomy/Fistula; W/O Plastic Repair | Colorado Prior Authorization List, Pg 37 Original policy |
| 32408 | Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed | Colorado Prior Authorization List, Pg 37 Original policy |
| 32555 | Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance | Colorado Prior Authorization List, Pg 37 Original policy |
| 32557 | Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance | Colorado Prior Authorization List, Pg 37 Original policy |
| 32701 | Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment | Colorado Prior Authorization List, Pg 37 Original policy |
| 32850 | Donor pneumonectomy(s) (including cold preservation), from cadaver donor | Colorado Prior Authorization List, Pg 37 Original policy |
| 32851 | Lung Transplant, Single; W/O Cardiopulmonary Bypass | Colorado Prior Authorization List, Pg 37 Original policy |
| 32852 | Lung Transplant, Single; W/Cardiopulmonary Bypass | Colorado Prior Authorization List, Pg 37 Original policy |
| 32853 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/O Cardiopulmonary Bypass | Colorado Prior Authorization List, Pg 37 Original policy |
| 32854 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/Cardiopulmonary Bypass | Colorado Prior Authorization List, Pg 37 Original policy |
| 32855 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Unilateral | Colorado Prior Authorization List, Pg 37 Original policy |
| 32856 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Bilateral | Colorado Prior Authorization List, Pg 37 Original policy |
| 32994 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Colorado Prior Authorization List, Pg 37 Original policy |
| 32998 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Colorado Prior Authorization List, Pg 37 Original policy |
| 33140 | Transmyocardial Laser Revascularization, By Thoracotomy | Colorado Prior Authorization List, Pg 38 Original policy |
| 33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | Colorado Prior Authorization List, Pg 38 Original policy |
| 33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | Colorado Prior Authorization List, Pg 38 Original policy |