Anthem Blue Cross Blue Shield of Colorado prior authorization, page 15
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 |
|---|---|---|
| 33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | Colorado Prior Authorization List, Pg 38 Original policy |
| 33212 | Insertion of pacemaker pulse generator only; with existing single lead | Colorado Prior Authorization List, Pg 38 Original policy |
| 33213 | Insertion of pacemaker pulse generator only; with existing dual leads | Colorado Prior Authorization List, Pg 38 Original policy |
| 33214 | Repositioning, Previously Implanted Transvenous Electrode/Pacing Cardiovert- Defib Electrode | Colorado Prior Authorization List, Pg 38 Original policy |
| 33215 | Repositioning of Previously Implanted Transvenous Pacemaker or Pacing Cardioverter-Defibrillator Electrode | Colorado Prior Authorization List, Pg 38 Original policy |
| 33216 | Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator | Colorado Prior Authorization List, Pg 38 Original policy |
| 33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter- defibrillator | Colorado Prior Authorization List, Pg 38 Original policy |
| 33218 | Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator | Colorado Prior Authorization List, Pg 38 Original policy |
| 33220 | Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter-defibrillator | Colorado Prior Authorization List, Pg 38 Original policy |
| 33222 | Relocation of skin pocket for pacemaker | Colorado Prior Authorization List, Pg 38 Original policy |
| 33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter- defibrillator pulse ge | Colorado Prior Authorization List, Pg 38 Original policy |
| 33226 | Repositioning Of Previously Implanted Cardiac Venous System (Left Ventricular) Electrode (Including Removal, Insertion And/Or Replacement Of Existing Generator) | Colorado Prior Authorization List, Pg 39 Original policy |
| 33227 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Single Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33228 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Dual Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33229 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Multiple Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33230 | Insertion Of Pacing Cardioverter-Defibrillator Pulse Generator Only; With Existing Dual Leads | Colorado Prior Authorization List, Pg 39 Original policy |
| 33231 | Insertion Of Pacing Cardioverter-Defibrillator Pulse Generator Only; With Existing Multiple Leads | Colorado Prior Authorization List, Pg 39 Original policy |
| 33233 | Removal of permanent pacemaker pulse generator only | Colorado Prior Authorization List, Pg 39 Original policy |
| 33234 | Removal, Transvenous Pacemaker Electrode(S); Single Lead System, Atrial/Ventricular | Colorado Prior Authorization List, Pg 39 Original policy |
| 33235 | Removal, Transvenous Pacemaker Electrode(S); Dual Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33240 | Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead | Colorado Prior Authorization List, Pg 39 Original policy |
| 33249 | Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber | Colorado Prior Authorization List, Pg 39 Original policy |
| 33263 | Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Dual Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33264 | Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Multiple Lead System | Colorado Prior Authorization List, Pg 39 Original policy |
| 33267 | Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | Colorado Prior Authorization List, Pg 39 Original policy |
| 33269 | Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | Colorado Prior Authorization List, Pg 39 Original policy |
| 33270 | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of a | Colorado Prior Authorization List, Pg 40 Original policy |
| 33271 | Insertion of subcutaneous implantable defibrillator electrode | Colorado Prior Authorization List, Pg 40 Original policy |
| 33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, fe | Colorado Prior Authorization List, Pg 40 Original policy |
| 33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) | Colorado Prior Authorization List, Pg 40 Original policy |
| 33276 | Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial ana | Colorado Prior Authorization List, Pg 40 Original policy |
| 33278 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; system, including pulse generat | Colorado Prior Authorization List, Pg 40 Original policy |
| 33279 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sens | Colorado Prior Authorization List, Pg 40 Original policy |
| 33280 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator only | Colorado Prior Authorization List, Pg 40 Original policy |
| 33281 | Repositioning of phrenic nerve stimulator transvenous lead(s) | Colorado Prior Authorization List, Pg 40 Original policy |
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | Colorado Prior Authorization List, Pg 40 Original policy |
| 33287 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator | Colorado Prior Authorization List, Pg 40 Original policy |
| 33288 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous sti | Colorado Prior Authorization List, Pg 40 Original policy |
| 33289 | Transcatheter implantation of wireless pulmonary artery pressure sensor for long- term hemodynamic monitoring, including deployment and calibration of the sensor, right heart c | Colorado Prior Authorization List, Pg 40 Original policy |
| 33340 | Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angio | Colorado Prior Authorization List, Pg 40 Original policy |
| 33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | Colorado Prior Authorization List, Pg 40 Original policy |
| 33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | Colorado Prior Authorization List, Pg 40 Original policy |
| 33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | Colorado Prior Authorization List, Pg 40 Original policy |
| 33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | Colorado Prior Authorization List, Pg 40 Original policy |
| 33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) | Colorado Prior Authorization List, Pg 41 Original policy |
| 33366 | Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transapical exposure (eg, left thoracotomy) | Colorado Prior Authorization List, Pg 41 Original policy |
| 33418 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis | Colorado Prior Authorization List, Pg 41 Original policy |
| 33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | Colorado Prior Authorization List, Pg 41 Original policy |
| 33927 | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | Colorado Prior Authorization List, Pg 41 Original policy |
| 33928 | Removal and replacement of total replacement heart system (artificial heart) | Colorado Prior Authorization List, Pg 41 Original policy |