Anthem Blue Cross Blue Shield of Colorado prior authorization, page 2
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 |
|---|---|---|
| 11601 | Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam 0.6 To 1.0 Cm | Colorado Prior Authorization List, Pg 3 Original policy |
| 11602 | Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam 1.1 To 2.0 Cm | Colorado Prior Authorization List, Pg 3 Original policy |
| 11603 | Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm | Colorado Prior Authorization List, Pg 3 Original policy |
| 11604 | Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam 3.1 To 4.0 Cm | Colorado Prior Authorization List, Pg 3 Original policy |
| 11606 | Excision, Malignant Lesion, Incl Margins, Trunk/Arms/Legs; Excised Diam > 4.0 Cm | Colorado Prior Authorization List, Pg 3 Original policy |
| 11620 | Excision, Malignant Lesion, Incl Margins, Scalp/Neck/Hands/Feet/Genitalia; Excised Diam 0.5 Cm/< | Colorado Prior Authorization List, Pg 4 Original policy |
| 11621 | Excision, Malignant Lesion, Incl Margins, Scalp/Neck/Hands/Feet/Genitalia; Excised Diam 0.6-1.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11622 | Excision, Malignant Lesion, Incl Margins, Scalp/Neck/Hands/Feet/Genitalia; Excised Diam 1.1-2.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11623 | Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11624 | Excision, Malignant Lesion, Incl Margins, Scalp/Neck/Hands/Feet/Genitalia; Excised Diam 3.1-4.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11626 | Excision, Malignant Lesion, Incl Margins, Scalp/Neck/Hands/Feet/Genitalia; Excised Diam > 4.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11640 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 0.5 Cm/< | Colorado Prior Authorization List, Pg 4 Original policy |
| 11641 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 0.6-1.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11642 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 1.1-2.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11643 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 2.1-3.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11644 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam 3.1-4.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11646 | Excision, Malignant Lesion, Incl Margins, Face/Ears/Eyelids/Nose/Lips/Muco; Excised Diam > 4.0 Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11730 | Avulsion, Nail Plate, Partial/Complete, Simple; Single | Colorado Prior Authorization List, Pg 4 Original policy |
| 11750 | Excision, Nail/Nail Matrix, Permanent Removal | Colorado Prior Authorization List, Pg 4 Original policy |
| 11755 | Bx, Nail Unit (Sep Proc) | Colorado Prior Authorization List, Pg 4 Original policy |
| 11760 | Repair, Nail Bed | Colorado Prior Authorization List, Pg 4 Original policy |
| 11765 | Wedge Excision, Skin, Nail Fold | Colorado Prior Authorization List, Pg 4 Original policy |
| 11770 | Excision, Pilonidal Cyst/Sinus; Simple | Colorado Prior Authorization List, Pg 4 Original policy |
| 11772 | Excision, Pilonidal Cyst/Sinus; Complicated | Colorado Prior Authorization List, Pg 4 Original policy |
| 11900 | Injection, Intralesional; Up To & Incl 7 Lesions | Colorado Prior Authorization List, Pg 4 Original policy |
| 11920 | Tattooing To Correct Color Defects; 6.0 Sq Cm/< | Colorado Prior Authorization List, Pg 4 Original policy |
| 11921 | Tattooing To Correct Color Defects; 6.1-20.0 Sq Cm | Colorado Prior Authorization List, Pg 4 Original policy |
| 11950 | Subq Injection, Filling Matl; 1 Cc/< | Colorado Prior Authorization List, Pg 4 Original policy |
| 11951 | Subq Injection, Filling Matl; 1.1 To 5.0 Cc | Colorado Prior Authorization List, Pg 4 Original policy |
| 11952 | Subq Injection, Filling Matl; 5.1 To 10.0 Cc | Colorado Prior Authorization List, Pg 4 Original policy |
| 11954 | Subq Injection, Filling Matl; > 10.0 Cc | Colorado Prior Authorization List, Pg 4 Original policy |
| 12001 | Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.5 Cm/< | Colorado Prior Authorization List, Pg 5 Original policy |
| 12002 | Simple Repair, Superficial Wounds, Scalp/Neck/Axillae/Genitalia/Trunk/Extremities; 2.6-7.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12011 | Simple Repair, Superficial Wounds, Face/Ears/Eyelids/Nose/Lips/Mucous Membranes; 2.5 Cm/< | Colorado Prior Authorization List, Pg 5 Original policy |
| 12020 | Treatment, Superficial Wound Dehiscence; Simple Closure | Colorado Prior Authorization List, Pg 5 Original policy |
| 12031 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less | Colorado Prior Authorization List, Pg 5 Original policy |
| 12032 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12034 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12035 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12037 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12041 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less | Colorado Prior Authorization List, Pg 5 Original policy |
| 12042 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 12051 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | Colorado Prior Authorization List, Pg 5 Original policy |
| 12052 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13100 | Repair, Complex, Trunk; 1.1 To 2.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13101 | Repair, Complex, Trunk; 2.6 To 7.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13120 | Repair, Complex, Scalp, Arms, &/Or Legs; 1.1 To 2.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13121 | Repair, Complex, Scalp, Arms, &/Or Legs; 2.6 To 7.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13131 | Repair, Complex, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 1.1-2.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |
| 13132 | Repair, Complex, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 2.6-7.5 Cm | Colorado Prior Authorization List, Pg 5 Original policy |