Anthem Blue Cross Blue Shield of Colorado prior authorization, page 22
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 |
|---|---|---|
| 47000 | Biopsy Of Liver, Needle; Percutaneous | Colorado Prior Authorization List, Pg 54 Original policy |
| 47133 | Donor Hepatectomy, W/Preparation & Maintenance, Allograft; Cadaver Donor | Colorado Prior Authorization List, Pg 54 Original policy |
| 47135 | Liver Allotransplantation; Orthotopic, Partial/Whole, Cadaver/Living Donor, Any Age | Colorado Prior Authorization List, Pg 54 Original policy |
| 47140 | Donor Hepatectomy, with Preparation and Maintenance of Allograft, Living Donor; Left Lateral Segment Only | Colorado Prior Authorization List, Pg 54 Original policy |
| 47141 | Donor Hepatectomy, with Preparation and Maintenance of Allograft, Living Donor; Total Left Lobectomy | Colorado Prior Authorization List, Pg 54 Original policy |
| 47142 | Donor Hepatectomy, with Preparation and Maintenance of Allograft, Living Donor; Total Right Lobectomy | Colorado Prior Authorization List, Pg 54 Original policy |
| 47143 | Backbench Standard Preparation Of Cadaver Donor Whole Liver Graft; Without Trisegment Or Lobe Split | Colorado Prior Authorization List, Pg 54 Original policy |
| 47144 | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectom | Colorado Prior Authorization List, Pg 54 Original policy |
| 47145 | Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectom | Colorado Prior Authorization List, Pg 54 Original policy |
| 47146 | Backbench Reconstruction Of Cadaver Or Living Donor Liver Graft Prior To Allotransplantation; Venous Anastomosis, Each | Colorado Prior Authorization List, Pg 54 Original policy |
| 47147 | Backbench Reconstruction Of Cadaver Or Living Donor Liver Graft Prior To Allotransplantation; Arterial Anastomosis, Each | Colorado Prior Authorization List, Pg 54 Original policy |
| 48160 | Pancreatectomy, Total/Subtotal W/Autologous Transplantation Pancreas/Pancreatic Islets | Colorado Prior Authorization List, Pg 54 Original policy |
| 48550 | Donor Pancreatectomy, W/Prep & Maintenance, Cadaver Donor, W/Wo Duodenal Segment | Colorado Prior Authorization List, Pg 54 Original policy |
| 48551 | Backbench Standard Preparation Of Cadaver Donor Pancreas Allograft | Colorado Prior Authorization List, Pg 54 Original policy |
| 48552 | Backbench Reconstruction Of Cadaver Donor Pancreas Allograft Prior To Transplantation, Venous Anastomosis, Each | Colorado Prior Authorization List, Pg 54 Original policy |
| 48554 | Transplantation, Pancreatic Allograft | Colorado Prior Authorization List, Pg 54 Original policy |
| 48556 | Removal, Transplanted Pancreatic Allograft | Colorado Prior Authorization List, Pg 54 Original policy |
| 49083 | Abdominal Paracentesis (Diagnostic Or Therapeutic); With Imaging Guidance | Colorado Prior Authorization List, Pg 55 Original policy |
| 49180 | Bx, Abdominal/Retroperitoneal Mass, Percutaneous Needle | Colorado Prior Authorization List, Pg 55 Original policy |
| 49500 | Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49505 | Repair initial inguinal hernia, age 5 years or older; reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49507 | Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49520 | Repair, Recurrent Inguinal Hernia, Any Age; Reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49521 | Repair, Recurrent Inguinal Hernia, Any Age; Incarcerated/Strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49525 | Repair, Inguinal Hernia, Sliding, Any Age | Colorado Prior Authorization List, Pg 55 Original policy |
| 49550 | Repair, Initial Femoral Hernia, Any Age; Reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49553 | Repair, Initial Femoral Hernia, Any Age; Incarcerated/Strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49560 | Repair, Initial Incisional/Ventral Hernia; Reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49561 | Repair, Initial Incisional/Ventral Hernia; Incarcerated/Strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49570 | Repair, Epigastric Hernia; Reducible (Sep Proc) | Colorado Prior Authorization List, Pg 55 Original policy |
| 49572 | Repair, Epigastric Hernia; Incarcerated/Strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49585 | Repair umbilical hernia, age 5 years or older; reducible | Colorado Prior Authorization List, Pg 55 Original policy |
| 49587 | Repair umbilical hernia, age 5 years or older; incarcerated or strangulated | Colorado Prior Authorization List, Pg 55 Original policy |
| 49591 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 55 Original policy |
| 49592 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 56 Original policy |
| 49593 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 56 Original policy |
| 49594 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 56 Original policy |
| 49595 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 56 Original policy |
| 49596 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implanta | Colorado Prior Authorization List, Pg 56 Original policy |
| 49613 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49614 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49615 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49616 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49617 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49618 | Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implan | Colorado Prior Authorization List, Pg 56 Original policy |
| 49650 | Laparoscopy, Surgical; Repair, Inguinal Hernia, Initial | Colorado Prior Authorization List, Pg 56 Original policy |
| 49651 | Laparoscopy, Surgical; Repair, Inguinal Hernia, Recurrent | Colorado Prior Authorization List, Pg 56 Original policy |
| 49652 | Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when perform | Colorado Prior Authorization List, Pg 57 Original policy |
| 49653 | Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when perform | Colorado Prior Authorization List, Pg 57 Original policy |
| 49654 | Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible | Colorado Prior Authorization List, Pg 57 Original policy |