Anthem Blue Cross Blue Shield of Colorado prior authorization, page 32
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 |
|---|---|---|
| 64868 | Anastomosis; Facial-Hypoglossal | Colorado Prior Authorization List, Pg 79 Original policy |
| 65275 | Repair, Laceration; Cornea, Nonperforating, W/Wo Removal Fb | Colorado Prior Authorization List, Pg 79 Original policy |
| 65400 | Excision, Lesion, Cornea (Keratectomy, Lamellar, Partial), Except Pterygium | Colorado Prior Authorization List, Pg 79 Original policy |
| 65420 | Excision/Transposition, Pterygium; W/O Graft | Colorado Prior Authorization List, Pg 79 Original policy |
| 65426 | Excision/Transposition, Pterygium; W/Graft | Colorado Prior Authorization List, Pg 79 Original policy |
| 65435 | Removal, Corneal Epithelium; W/Wo Chemocauterization (Abrasion, Curettage) | Colorado Prior Authorization List, Pg 79 Original policy |
| 65436 | Removal, Corneal Epithelium; W/Application, Chelating Agent | Colorado Prior Authorization List, Pg 79 Original policy |
| 65710 | Keratoplasty (corneal transplant); anterior lamellar | Colorado Prior Authorization List, Pg 79 Original policy |
| 65730 | Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) | Colorado Prior Authorization List, Pg 79 Original policy |
| 65750 | Keratoplasty (Corneal Transplant); Penetrating (In Aphakia) | Colorado Prior Authorization List, Pg 79 Original policy |
| 65755 | Keratoplasty (Corneal Transplant); Penetrating (In Pseudophakia) | Colorado Prior Authorization List, Pg 79 Original policy |
| 65756 | Keratoplasty (corneal transplant); endothelial | Colorado Prior Authorization List, Pg 79 Original policy |
| 65778 | Placement of amniotic membrane on the ocular surface; without sutures | Colorado Prior Authorization List, Pg 79 Original policy |
| 65779 | Placement of amniotic membrane on the ocular surface; single layer, sutured | Colorado Prior Authorization List, Pg 79 Original policy |
| 65780 | Ocular surface reconstruction; amniotic membrane transplantation, multiple layers | Colorado Prior Authorization List, Pg 79 Original policy |
| 65800 | Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous | Colorado Prior Authorization List, Pg 79 Original policy |
| 65815 | Paracentesis, Eye, Anterior Chamber (Sep Proc); W/Removal, Blood, W/Wo Irrigation/Air Injection | Colorado Prior Authorization List, Pg 79 Original policy |
| 65820 | Goniotomy | Colorado Prior Authorization List, Pg 79 Original policy |
| 65850 | Trabeculotomy Ab Externo | Colorado Prior Authorization List, Pg 79 Original policy |
| 65855 | Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series) | Colorado Prior Authorization List, Pg 79 Original policy |
| 65865 | Severing Adhesions, Anterior Segment, Eye, Incisional (Sep Proc); Goniosynechiae | Colorado Prior Authorization List, Pg 79 Original policy |
| 65875 | Severing Adhesions, Anterior Segment, Eye, Incisional (Sep Proc); Posterior Synechiae | Colorado Prior Authorization List, Pg 79 Original policy |
| 65920 | Removal, Implanted Material, Anterior Segment, Eye | Colorado Prior Authorization List, Pg 79 Original policy |
| 66020 | Injection, Anterior Chamber, Eye (Sep Proc); Air/Liquid | Colorado Prior Authorization List, Pg 79 Original policy |
| 66170 | Fistulization, Sclera, Glaucoma; Trabeculectomy Ab Externo In Absence, Previous Surgery | Colorado Prior Authorization List, Pg 79 Original policy |
| 66172 | Fistulization, Sclera, Glaucoma; Trabeculectomy Ab Externo W/Scarring, Previous Surg/Trauma | Colorado Prior Authorization List, Pg 79 Original policy |
| 66174 | Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stent | Colorado Prior Authorization List, Pg 79 Original policy |
| 66175 | Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stent | Colorado Prior Authorization List, Pg 79 Original policy |
| 66179 | Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft | Colorado Prior Authorization List, Pg 79 Original policy |
| 66180 | Aqueous Shunt To Extraocular Reservoir | Colorado Prior Authorization List, Pg 80 Original policy |
| 66183 | Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach | Colorado Prior Authorization List, Pg 80 Original policy |
| 66184 | Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft | Colorado Prior Authorization List, Pg 80 Original policy |
| 66185 | Revision, Aqueous Shunt To Extraocular Reservoir | Colorado Prior Authorization List, Pg 80 Original policy |
| 66250 | Revision/Repair, Operative Wound, Anterior Segment, Any Type | Colorado Prior Authorization List, Pg 80 Original policy |
| 66682 | Suture, Iris, Ciliary Body (Sep Proc) W/Suture Retrieval W/Small Incision | Colorado Prior Authorization List, Pg 80 Original policy |
| 66683 | Iris prosthesis Implantation | Colorado Prior Authorization List, Pg 80 Original policy |
| 66710 | Ciliary Body Destruction; Cyclophotocoagulation | Colorado Prior Authorization List, Pg 80 Original policy |
| 66711 | Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens | Colorado Prior Authorization List, Pg 80 Original policy |
| 66761 | Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session) | Colorado Prior Authorization List, Pg 80 Original policy |
| 66762 | Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of anterior chamber an | Colorado Prior Authorization List, Pg 80 Original policy |
| 66821 | Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (e | Colorado Prior Authorization List, Pg 80 Original policy |
| 66825 | Repositioning, Intraocular Lens Prosthesis, Requiring An Incision (Sep Proc) | Colorado Prior Authorization List, Pg 80 Original policy |
| 66840 | Removal of lens material; aspiration technique, 1 or more stages | Colorado Prior Authorization List, Pg 80 Original policy |
| 66850 | Removal, Lens Material; Phacofragmentation, W/Aspiration | Colorado Prior Authorization List, Pg 80 Original policy |
| 66852 | Removal, Lens Material; Pars Plana Approach, W/Wo Vitrectomy | Colorado Prior Authorization List, Pg 80 Original policy |
| 66982 | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsif | Colorado Prior Authorization List, Pg 80 Original policy |
| 66983 | Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) | Colorado Prior Authorization List, Pg 80 Original policy |
| 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsif | Colorado Prior Authorization List, Pg 80 Original policy |
| 66985 | Insertion, Intraocular Lens Prosthesis (Secondary Implant) (No Concurrent Cataract Removal) | Colorado Prior Authorization List, Pg 80 Original policy |
| 66986 | Exchange, Intraocular Lens | Colorado Prior Authorization List, Pg 80 Original policy |