Anthem Blue Cross Blue Shield of Colorado prior authorization, page 33
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 |
|---|---|---|
| 66987 | 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 |
| 66988 | 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 |
| 66989 | 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 |
| 66991 | 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 |
| 67005 | Removal, Vitreous, Anterior Approach; Partial Removal | Colorado Prior Authorization List, Pg 80 Original policy |
| 67010 | Removal, Vitreous, Anterior Approach; Subtotal Removal W/Mech Vitrectomy | Colorado Prior Authorization List, Pg 80 Original policy |
| 67015 | Aspiration/Release, Vitreous/Subretinal/Choroidal Fluid, Pars Plana Approach | Colorado Prior Authorization List, Pg 80 Original policy |
| 67025 | Injection, Vitreous Substitute, Pars Plana/Limbal Approach, W/Wo Aspiration (Sep Proc) | Colorado Prior Authorization List, Pg 81 Original policy |
| 67027 | Implant, Intravitreal Drug Delivery System W/Removal, Vitreous | Colorado Prior Authorization List, Pg 81 Original policy |
| 67028 | Intravitreal Injection, A Pharmacologic Agent (Sep Proc) | Colorado Prior Authorization List, Pg 81 Original policy |
| 67031 | Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages) | Colorado Prior Authorization List, Pg 81 Original policy |
| 67036 | Vitrectomy, Mechanical, Pars Plana Approach | Colorado Prior Authorization List, Pg 81 Original policy |
| 67039 | Vitrectomy, Mechanical, Pars Plana Approach; W/Focal Endolaser Photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67040 | Vitrectomy, Mechanical, Pars Plana Approach; W/Endolaser Panretinal Photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67041 | Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g. macular pucker) | Colorado Prior Authorization List, Pg 81 Original policy |
| 67042 | Vitrectomy,mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg for repair of macul | Colorado Prior Authorization List, Pg 81 Original policy |
| 67043 | Vitrectomy,mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), incl | Colorado Prior Authorization List, Pg 81 Original policy |
| 67101 | Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy | Colorado Prior Authorization List, Pg 81 Original policy |
| 67105 | Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67107 | Repair, Retinal Detachment; Scleral Buckling, W/Wo Implant/Cryo/Photocoag/Subretinal Drainage | Colorado Prior Authorization List, Pg 81 Original policy |
| 67108 | Repair, Retinal Detachment; W/Vitrectomy, Any Method, W/Wo Tamponade/Laser/Cryo/Drain/Lens Removal | Colorado Prior Authorization List, Pg 81 Original policy |
| 67110 | Repair, Retinal Detachment; Injection, Air/Other Gas | Colorado Prior Authorization List, Pg 81 Original policy |
| 67113 | Repair of complex retinal detachment (eg. Proliferative vitreoretinopathy, stage C- 1 or greater, diabetic traction retin | Colorado Prior Authorization List, Pg 81 Original policy |
| 67120 | Removal, Implanted Matl, Posterior Segment; Extraocular | Colorado Prior Authorization List, Pg 81 Original policy |
| 67121 | Removal, Implanted Matl, Posterior Segment; Intraocular | Colorado Prior Authorization List, Pg 81 Original policy |
| 67141 | Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy | Colorado Prior Authorization List, Pg 81 Original policy |
| 67145 | Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67210 | Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67218 | Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of | Colorado Prior Authorization List, Pg 81 Original policy |
| 67221 | Destruction, Localized Lesion, Choroid; Photodynamic Therapy (W/Iv Infusion) | Colorado Prior Authorization List, Pg 81 Original policy |
| 67228 | Treatment of extensive or progressive retinopathy, 1 or more sessions; (eg, diabetic retinopathy), photocoagulation | Colorado Prior Authorization List, Pg 81 Original policy |
| 67311 | Strabismus surgery, recession or resection procedure; 1 horizontal muscle | Colorado Prior Authorization List, Pg 81 Original policy |
| 67312 | Strabismus surgery, recession or resection procedure; 2 horizontal muscles | Colorado Prior Authorization List, Pg 81 Original policy |
| 67314 | Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique) | Colorado Prior Authorization List, Pg 82 Original policy |
| 67316 | Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique) | Colorado Prior Authorization List, Pg 82 Original policy |
| 67318 | Strabismus Surgery, Any Proc, Superior Oblique Muscle | Colorado Prior Authorization List, Pg 82 Original policy |
| 67345 | Chemodenervation, Extraocular Muscle | Colorado Prior Authorization List, Pg 82 Original policy |
| 67400 | Orbitotomy W/O Bone Flap; Exploration, W/Wo Bx | Colorado Prior Authorization List, Pg 82 Original policy |
| 67412 | Orbitotomy W/O Bone Flap; W/Removal, Lesion | Colorado Prior Authorization List, Pg 82 Original policy |
| 67414 | Orbitotomy W/O Bone Flap; W/Removal, Bone, Decompression | Colorado Prior Authorization List, Pg 82 Original policy |
| 67420 | Orbitotomy W/Bone Flap/Window, Lateral Approach; W/Removal, Lesion | Colorado Prior Authorization List, Pg 82 Original policy |
| 67445 | Orbitotomy W/Bone Flap/Window, Lateral Approach; W/Removal, Bone, Decompression | Colorado Prior Authorization List, Pg 82 Original policy |
| 67550 | Orbital Implant (Outside Muscle Cone); Insertion | Colorado Prior Authorization List, Pg 82 Original policy |
| 67560 | Orbital Implant (Outside Muscle Cone); Removal/Revision | Colorado Prior Authorization List, Pg 82 Original policy |
| 67700 | Blepharotomy, Drainage, Abscess, Eyelid | Colorado Prior Authorization List, Pg 82 Original policy |
| 67800 | Excision, Chalazion; Single | Colorado Prior Authorization List, Pg 82 Original policy |
| 67801 | Excision, Chalazion; Multiple, Same Lid | Colorado Prior Authorization List, Pg 82 Original policy |
| 67805 | Excision, Chalazion; Multiple, Different Lids | Colorado Prior Authorization List, Pg 82 Original policy |
| 67808 | Excision, Chalazion; W/Anesthesia/Hospitalization, Single/Multiple | Colorado Prior Authorization List, Pg 82 Original policy |
| 67810 | Incisional biopsy of eyelid skin including lid margin | Colorado Prior Authorization List, Pg 82 Original policy |