Anthem Blue Cross Blue Shield of Colorado prior authorization, page 18
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 |
|---|---|---|
| 40814 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/Complex Repair | Colorado Prior Authorization List, Pg 47 Original policy |
| 40816 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; Complex, W/Excision, Muscle | Colorado Prior Authorization List, Pg 47 Original policy |
| 41010 | Incision, Lingual Frenum (Frenotomy) | Colorado Prior Authorization List, Pg 47 Original policy |
| 41019 | Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transn | Colorado Prior Authorization List, Pg 47 Original policy |
| 41100 | Bx, Tongue; Anterior Two-Thirds | Colorado Prior Authorization List, Pg 47 Original policy |
| 41105 | Bx, Tongue; Posterior One-Third | Colorado Prior Authorization List, Pg 47 Original policy |
| 41108 | Bx, Mouth, Floor | Colorado Prior Authorization List, Pg 47 Original policy |
| 41110 | Excision, Lesion, Tongue W/O Closure | Colorado Prior Authorization List, Pg 47 Original policy |
| 41112 | Excision, Lesion, Tongue W/Closure; Anterior Two-Thirds | Colorado Prior Authorization List, Pg 47 Original policy |
| 41113 | Excision, Lesion, Tongue W/Closure; Posterior One-Third | Colorado Prior Authorization List, Pg 47 Original policy |
| 41116 | Excision, Lesion, Mouth Floor | Colorado Prior Authorization List, Pg 47 Original policy |
| 41512 | Tongue base suspension, permanent suture technique | Colorado Prior Authorization List, Pg 47 Original policy |
| 41520 | Frenoplasty | Colorado Prior Authorization List, Pg 47 Original policy |
| 41530 | Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session | Colorado Prior Authorization List, Pg 47 Original policy |
| 41825 | Excision, Lesion/Tumor (Except Listed Above), Dentoalveolar Structures; W/O Repair | Colorado Prior Authorization List, Pg 47 Original policy |
| 42100 | Bx, Palate, Uvula | Colorado Prior Authorization List, Pg 47 Original policy |
| 42104 | Excision, Lesion, Palate, Uvula; W/O Closure | Colorado Prior Authorization List, Pg 47 Original policy |
| 42106 | Excision, Lesion, Palate, Uvula; W/Simple Primary Closure | Colorado Prior Authorization List, Pg 47 Original policy |
| 42107 | Excision, Lesion, Palate, Uvula; W/Local Flap Closure | Colorado Prior Authorization List, Pg 47 Original policy |
| 42140 | Uvulectomy, Excision, Uvula | Colorado Prior Authorization List, Pg 47 Original policy |
| 42145 | Palatopharyngoplasty | Colorado Prior Authorization List, Pg 47 Original policy |
| 42330 | Sialolithotomy; Submandibular (Submaxillary), Sublingual/Parotid, Uncomplicated, Intraoral | Colorado Prior Authorization List, Pg 47 Original policy |
| 42335 | Sialolithotomy; Submandibular (Submaxillary), Complicated, Intraoral | Colorado Prior Authorization List, Pg 47 Original policy |
| 42405 | Bx, Salivary Gland; Incisional | Colorado Prior Authorization List, Pg 47 Original policy |
| 42408 | Excision, Sublingual Salivary Cyst (Ranula) | Colorado Prior Authorization List, Pg 47 Original policy |
| 42410 | Excision, Parotid Tumor/Parotid Gland; Lateral Lobe, W/O Nerve Dissection | Colorado Prior Authorization List, Pg 48 Original policy |
| 42415 | Excision, Parotid Tumor/Parotid Gland; Lateral Lobe, W/Nerve Dissection, Preservation, Facial Nerve | Colorado Prior Authorization List, Pg 48 Original policy |
| 42420 | Excision, Parotid Tumor/Parotid Gland; Total, W/Nerve Dissection, Preservation, Facial Nerve | Colorado Prior Authorization List, Pg 48 Original policy |
| 42425 | Excision, Parotid Tumor/Parotid Gland; Total, En Bloc, Nerve Removal | Colorado Prior Authorization List, Pg 48 Original policy |
| 42440 | Excision, Submandibular (Submaxillary) Gland | Colorado Prior Authorization List, Pg 48 Original policy |
| 42450 | Excision, Sublingual Gland | Colorado Prior Authorization List, Pg 48 Original policy |
| 42500 | Plastic Repair, Salivary Duct, Sialodochoplasty; Primary/Simple | Colorado Prior Authorization List, Pg 48 Original policy |
| 42650 | Dilation Salivary Duct | Colorado Prior Authorization List, Pg 48 Original policy |
| 42800 | Bx; Oropharynx | Colorado Prior Authorization List, Pg 48 Original policy |
| 42804 | Bx; Nasopharynx, Visible Lesion, Simple | Colorado Prior Authorization List, Pg 48 Original policy |
| 42808 | Excision/Destruction, Lesion, Pharynx, Any Method | Colorado Prior Authorization List, Pg 48 Original policy |
| 42810 | Excision, Branchial Cleft Cyst/Vestige, Confined To Skin & Subq Tissues | Colorado Prior Authorization List, Pg 48 Original policy |
| 42870 | Excision/Destruction Lingual Tonsil, Any Method (Sep Proc) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43192 | Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance | Colorado Prior Authorization List, Pg 48 Original policy |
| 43195 | Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43197 | Esophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) by brushing or washing when performed (separate procedure) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43200 | Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43201 | Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance | Colorado Prior Authorization List, Pg 48 Original policy |
| 43202 | Esophagoscopy, flexible, transoral; with biopsy, single or multiple | Colorado Prior Authorization List, Pg 48 Original policy |
| 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed | Colorado Prior Authorization List, Pg 48 Original policy |
| 43214 | Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43220 | Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) | Colorado Prior Authorization List, Pg 48 Original policy |
| 43226 | Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire | Colorado Prior Authorization List, Pg 48 Original policy |
| 43228 | Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique | Colorado Prior Authorization List, Pg 48 Original policy |
| 43229 | Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | Colorado Prior Authorization List, Pg 48 Original policy |