Anthem Blue Cross Blue Shield of Colorado prior authorization, page 17
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 |
|---|---|---|
| 37224 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty | Colorado Prior Authorization List, Pg 43 Original policy |
| 37225 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed | Colorado Prior Authorization List, Pg 43 Original policy |
| 37226 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same ves | Colorado Prior Authorization List, Pg 43 Original policy |
| 37227 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty wit | Colorado Prior Authorization List, Pg 44 Original policy |
| 37228 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty | Colorado Prior Authorization List, Pg 44 Original policy |
| 37229 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when | Colorado Prior Authorization List, Pg 44 Original policy |
| 37230 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within t | Colorado Prior Authorization List, Pg 44 Original policy |
| 37231 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angi | Colorado Prior Authorization List, Pg 44 Original policy |
| 37238 | Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same ves | Colorado Prior Authorization List, Pg 44 Original policy |
| 37241 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the i | Colorado Prior Authorization List, Pg 44 Original policy |
| 37242 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the i | Colorado Prior Authorization List, Pg 44 Original policy |
| 37243 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the i | Colorado Prior Authorization List, Pg 44 Original policy |
| 37244 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the i | Colorado Prior Authorization List, Pg 44 Original policy |
| 37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and intepretation necessary to perform ang | Colorado Prior Authorization List, Pg 44 Original policy |
| 37607 | Ligation/Banding, Angioaccess Arteriovenous Fistula | Colorado Prior Authorization List, Pg 44 Original policy |
| 37609 | Ligation/Bx, Temporal Artery | Colorado Prior Authorization List, Pg 45 Original policy |
| 37761 | Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg | Colorado Prior Authorization List, Pg 45 Original policy |
| 38204 | Management, Recipient Hematopoietic Progenitor Cell Donor Search & Cell Acquisition | Colorado Prior Authorization List, Pg 45 Original policy |
| 38205 | Blood-Derived Hematopoietic Progenitor Cell Harvesting, Transplantation/Collection; Allogenic | Colorado Prior Authorization List, Pg 45 Original policy |
| 38206 | Blood-Derived Hematopoietic Progenitor Cell Harvesting, Transplantation/Collection; Autologous | Colorado Prior Authorization List, Pg 45 Original policy |
| 38207 | Transplant Preparation, Hematopoietic Progenitor Cells; Cryopreservation & Storage | Colorado Prior Authorization List, Pg 45 Original policy |
| 38208 | Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor | Colorado Prior Authorization List, Pg 45 Original policy |
| 38209 | Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor | Colorado Prior Authorization List, Pg 45 Original policy |
| 38210 | Transplant Prep, Hematopoietic Progenitor Cells; Specfc Cell Deplet W/In Harvest, T-Cell Deplete | Colorado Prior Authorization List, Pg 45 Original policy |
| 38211 | Transplant Preparation, Hematopoietic Progenitor Cells; Tumor Cell Deplete | Colorado Prior Authorization List, Pg 45 Original policy |
| 38212 | Transplant Preparation, Hematopoietic Progenitor Cells; Red Blood Cell Removal | Colorado Prior Authorization List, Pg 45 Original policy |
| 38213 | Transplant Preparation, Hematopoietic Progenitor Cells; Platelet Depletion | Colorado Prior Authorization List, Pg 45 Original policy |
| 38214 | Transplant Preparation, Hematopoietic Progenitor Cells; Plasma (Volume) Depletion | Colorado Prior Authorization List, Pg 46 Original policy |
| 38215 | Transplant Prep, Hematoiepotic Progenitor Cells; Cell Conc, Plasma/Mononuclear/Buffy Coat | Colorado Prior Authorization List, Pg 46 Original policy |
| 38221 | Diagnostic bone marrow; biopsy(ies) | Colorado Prior Authorization List, Pg 46 Original policy |
| 38222 | Diagnostic bone marrow; biopsy(ies) and aspiration(s) | Colorado Prior Authorization List, Pg 46 Original policy |
| 38230 | Bone marrow harvesting for transplantation; allogeneic | Colorado Prior Authorization List, Pg 46 Original policy |
| 38232 | Bone Marrow Harvesting For Transplantation; Autologous | Colorado Prior Authorization List, Pg 46 Original policy |
| 38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor | Colorado Prior Authorization List, Pg 46 Original policy |
| 38241 | Hematopoietic progenitor cell (HPC); autologous transplantation | Colorado Prior Authorization List, Pg 46 Original policy |
| 38243 | Hematopoietic progenitor cell (HPC); HPC boost | Colorado Prior Authorization List, Pg 46 Original policy |
| 38500 | Bx/Excision, Lymph Node(S); Superficial | Colorado Prior Authorization List, Pg 46 Original policy |
| 38505 | Bx/Excision, Lymph Node(S); Needle, Superficial | Colorado Prior Authorization List, Pg 46 Original policy |
| 38510 | Bx/Excision, Lymph Node(S); Open, Deep Cervical Node(S) | Colorado Prior Authorization List, Pg 46 Original policy |
| 38525 | Bx/Excision, Lymph Node(S); Open, Deep Axillary Node(S) | Colorado Prior Authorization List, Pg 46 Original policy |
| 38740 | Axillary Lymphadenectomy; Superficial | Colorado Prior Authorization List, Pg 46 Original policy |
| 38760 | Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure) | Colorado Prior Authorization List, Pg 46 Original policy |
| 40490 | Bx, Lip | Colorado Prior Authorization List, Pg 46 Original policy |
| 40510 | Excision, Lip; Transverse Wedge Excision W/Primary Closure | Colorado Prior Authorization List, Pg 46 Original policy |
| 40520 | Excision, Lip; V-Excision W/Primary Direct Linear Closure | Colorado Prior Authorization List, Pg 47 Original policy |
| 40525 | Excision, Lip; Full Thickness, Reconstruction W/Local Flap | Colorado Prior Authorization List, Pg 47 Original policy |
| 40530 | Resection, Lip, > One-Fourth, W/O Reconstruction | Colorado Prior Authorization List, Pg 47 Original policy |
| 40808 | Bx, Vestibule, Mouth | Colorado Prior Authorization List, Pg 47 Original policy |
| 40810 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/O Repair | Colorado Prior Authorization List, Pg 47 Original policy |
| 40812 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/Simple Repair | Colorado Prior Authorization List, Pg 47 Original policy |