Anthem Blue Cross Blue Shield of Colorado prior authorization, page 29
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 |
|---|---|---|
| 62287 | Decompression, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle-based technique to remove disc material under fluoroscopic imaging or othe | Colorado Prior Authorization List, Pg 69 Original policy |
| 62290 | Injection, Diskography, Each Level; Lumbar | Colorado Prior Authorization List, Pg 69 Original policy |
| 62291 | Injection, Diskography, Each Level; Cervical/Thoracic | Colorado Prior Authorization List, Pg 69 Original policy |
| 62320 | Injection(s) of diagnostic or therapeutic substance(s) (eg. anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle | Colorado Prior Authorization List, Pg 69 Original policy |
| 62321 | Injection(s) of diagnostic or therapeutic substance(s) (eg. anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle | Colorado Prior Authorization List, Pg 70 Original policy |
| 62322 | Injection(s) of diagnostic or therapeutic substances(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution) not including neurolytic substances, including needle | Colorado Prior Authorization List, Pg 70 Original policy |
| 62323 | Injection(s) of diagnostic or therapeutic substances(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution) not including neurolytic substances, including needle | Colorado Prior Authorization List, Pg 70 Original policy |
| 62350 | Implant/Revisn/Reposition Intrathecal/Epidural Catheter, Externl Reservor/Infusion Pump; W/O Laminct | Colorado Prior Authorization List, Pg 70 Original policy |
| 62351 | Implant/Revisn/Reposition Intrathecal/Epidural Catheter, Externl Reservor/Infusion Pump; W/Laminect | Colorado Prior Authorization List, Pg 70 Original policy |
| 62360 | Implantation/Replace, Device, Intrathecal/Epidural Drug Infusion; Subq Reservoir | Colorado Prior Authorization List, Pg 70 Original policy |
| 62361 | Implantation/Replace, Device, Intrathecal/Epidural Drug Infusion; Non- Programmable Pump | Colorado Prior Authorization List, Pg 70 Original policy |
| 62362 | Implantation/Replace, Device, Intrathecal/Epidural Drug Infusion; Programmable Pump | Colorado Prior Authorization List, Pg 70 Original policy |
| 62380 | Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc; 1 | Colorado Prior Authorization List, Pg 70 Original policy |
| 63001 | Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral s | Colorado Prior Authorization List, Pg 70 Original policy |
| 63003 | Laminectomy, W/O Facetectomy/Foraminotomy/Diskectomy, 1/2 Segments; Thoracic | Colorado Prior Authorization List, Pg 70 Original policy |
| 63005 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, 1/2 Segments; Lumbar | Colorado Prior Authorization List, Pg 70 Original policy |
| 63012 | Laminectomy W/Removal, Abnormal Facets, Lumbar | Colorado Prior Authorization List, Pg 70 Original policy |
| 63015 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Cervical | Colorado Prior Authorization List, Pg 70 Original policy |
| 63016 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Thoracic | Colorado Prior Authorization List, Pg 70 Original policy |
| 63017 | Laminectomy W/O Facetectomy/Foraminotomy/Diskectomy, > 2 Segments; Lumbar | Colorado Prior Authorization List, Pg 70 Original policy |
| 63020 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace | Colorado Prior Authorization List, Pg 71 Original policy |
| 63030 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace | Colorado Prior Authorization List, Pg 71 Original policy |
| 63035 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additiona | Colorado Prior Authorization List, Pg 71 Original policy |
| 63040 | Laminotomy W/Partl Facetectmy/Foramnotmy/Herniated Diskect, Re-Exploratn, Sngle Interspc; Cervical | Colorado Prior Authorization List, Pg 71 Original policy |
| 63042 | Laminotomy W/Partl Facetectomy/Foraminotomy/Herniated Diskect, Re-Explor, Sngle Interspc; Lumbar | Colorado Prior Authorization List, Pg 71 Original policy |
| 63043 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or ex | Colorado Prior Authorization List, Pg 71 Original policy |
| 63044 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or ex | Colorado Prior Authorization List, Pg 71 Original policy |
| 63045 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Colorado Prior Authorization List, Pg 72 Original policy |
| 63046 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Colorado Prior Authorization List, Pg 72 Original policy |
| 63047 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Colorado Prior Authorization List, Pg 72 Original policy |
| 63048 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Colorado Prior Authorization List, Pg 72 Original policy |
| 63050 | Laminoplasty, Cervical, With Decompression Of The Spinal Cord, Two Or More Vertebral Segments | Colorado Prior Authorization List, Pg 72 Original policy |
| 63051 | Laminoplasty, Cerv, W Decompression Of Spinal Cord, 2 Or > Verteb Segments; W Reconstruction Of Posterior Bony Elements | Colorado Prior Authorization List, Pg 72 Original policy |
| 63052 | Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | Colorado Prior Authorization List, Pg 72 Original policy |
| 63053 | Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | Colorado Prior Authorization List, Pg 72 Original policy |
| 63055 | Transpedicular Approach, 1 Segment; Thoracic | Colorado Prior Authorization List, Pg 72 Original policy |
| 63056 | Transpedicular Approach, 1 Segment; Lumbar (Transfacet/Lateral Extraforaminal) | Colorado Prior Authorization List, Pg 72 Original policy |
| 63057 | Transpedicular Approach, Add'l Segment; Thoracic/Lumbar | Colorado Prior Authorization List, Pg 72 Original policy |
| 63075 | Diskectomy, Anterior; Cervical, 1 Interspace | Colorado Prior Authorization List, Pg 73 Original policy |
| 63076 | Diskectomy, Anterior; Cervical, Add'l Interspace | Colorado Prior Authorization List, Pg 73 Original policy |
| 63081 | Vertebral Corpectomy, Anterior; Cervical, 1 Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63082 | Vertebral Corpectomy, Anterior; Cervical, Add'l Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63085 | Vertebral Corpectomy, Transthoracic; Thoracic, 1 Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63086 | Vertebral Corpectomy, Transthoracic; Thoracic, Add'l Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63087 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; 1 Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63088 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; Add'l Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63090 | Vertebral Corpectomy, Transperitoneal/Retroperitoneal, Lower Thoracic/Lumbar/Sacral; 1 Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63091 | Vertebral Corpectomy, Trans/Retroperitoneal, Lower Thoracic/Lumbar/Sacral; Add'l Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63101 | Vertebral Corpectomy, Lateral Extracavitary Approach w Decompression of Spinal Cord/Nerve Roots; Thoracic, Sgl Segment | Colorado Prior Authorization List, Pg 73 Original policy |
| 63102 | Vertebral Corpectomy, Lateral Extracavitary Approach w Decompression of Spinal Cord/Nerve Roots; Lumbar, Sgl Segment | Colorado Prior Authorization List, Pg 73 Original policy |