Anthem Blue Cross Blue Shield of Colorado prior authorization, page 34
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 |
|---|---|---|
| 67825 | Correction, Trichiasis; Epilation, Non-Forceps | Colorado Prior Authorization List, Pg 82 Original policy |
| 67840 | Excision, Lesion, Eyelid (Except Chalazion) W/O Closure Or W/Simple Direct Closure | Colorado Prior Authorization List, Pg 82 Original policy |
| 67875 | Temporary Closure, Eyelids, Suture | Colorado Prior Authorization List, Pg 82 Original policy |
| 67880 | Construction, Intermarginal Adhesions, Median Tarsorrhaphy/Canthorrhaphy | Colorado Prior Authorization List, Pg 82 Original policy |
| 67900 | Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach) | Colorado Prior Authorization List, Pg 82 Original policy |
| 67901 | Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) | Colorado Prior Authorization List, Pg 82 Original policy |
| 67902 | Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) | Colorado Prior Authorization List, Pg 82 Original policy |
| 67903 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Int Approach | Colorado Prior Authorization List, Pg 82 Original policy |
| 67904 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Ext Approach | Colorado Prior Authorization List, Pg 82 Original policy |
| 67906 | Repair, Blepharoptosis; Superior Rectus W/Fascial Sling | Colorado Prior Authorization List, Pg 82 Original policy |
| 67908 | Repair, Blepharoptosis; Conjunctivo-Tarso-Muller's Muscle-Levator Resection | Colorado Prior Authorization List, Pg 83 Original policy |
| 67911 | Correction, Lid Retraction | Colorado Prior Authorization List, Pg 83 Original policy |
| 67917 | Repair, Ectropion; Extensive | Colorado Prior Authorization List, Pg 83 Original policy |
| 67924 | Repair, Entropion; Blepharoplasty, Extensive | Colorado Prior Authorization List, Pg 83 Original policy |
| 67935 | Suture, Recent Wound, Eyelid; Full Thickness | Colorado Prior Authorization List, Pg 83 Original policy |
| 67938 | Removal, Embedded Fb, Eyelid | Colorado Prior Authorization List, Pg 83 Original policy |
| 67950 | Canthoplasty (Reconstruction, Canthus) | Colorado Prior Authorization List, Pg 83 Original policy |
| 67961 | Excision/Repair, Eyelid; Up T0 One Quarter, Lid Margin | Colorado Prior Authorization List, Pg 83 Original policy |
| 67966 | Excision/Repair, Eyelid; > One Quarter, Lid Margin | Colorado Prior Authorization List, Pg 83 Original policy |
| 67971 | Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to 2/3 of eyelid | Colorado Prior Authorization List, Pg 83 Original policy |
| 67973 | Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower | Colorado Prior Authorization List, Pg 83 Original policy |
| 67975 | Reconstruction, Eyelid, Full Thickness; 2nd Stage | Colorado Prior Authorization List, Pg 83 Original policy |
| 68100 | Bx, Conjunctiva | Colorado Prior Authorization List, Pg 83 Original policy |
| 68110 | Excision, Lesion, Conjunctiva; Up To 1 Cm | Colorado Prior Authorization List, Pg 83 Original policy |
| 68115 | Excision, Lesion, Conjunctiva; > 1 Cm | Colorado Prior Authorization List, Pg 83 Original policy |
| 68135 | Destruction, Lesion, Conjunctiva | Colorado Prior Authorization List, Pg 83 Original policy |
| 68320 | Conjunctivoplasty; W/Conjunctival Graft/Extensive Rearrangement | Colorado Prior Authorization List, Pg 83 Original policy |
| 68440 | Snip Incision, Lacrimal Punctum | Colorado Prior Authorization List, Pg 83 Original policy |
| 68530 | Removal, Fb/Dacryolith, Lacrimal Passages | Colorado Prior Authorization List, Pg 83 Original policy |
| 68700 | Plastic Repair, Canaliculi | Colorado Prior Authorization List, Pg 83 Original policy |
| 68720 | Dacryocystorhinostomy (Fistulization, Lacrimal Sac To Nasal Cavity) | Colorado Prior Authorization List, Pg 83 Original policy |
| 68750 | Conjunctivorhinostomy; W/Insertion, Tube/Stent | Colorado Prior Authorization List, Pg 83 Original policy |
| 68761 | Closure, Lacrimal Punctum; Plug, Each | Colorado Prior Authorization List, Pg 83 Original policy |
| 68801 | Dilation, Lacrimal Punctum, W/Wo Irrigation | Colorado Prior Authorization List, Pg 83 Original policy |
| 68811 | Probing, Nasolacrimal Duct, W/Wo Irrigation; Requiring General Anesthesia | Colorado Prior Authorization List, Pg 83 Original policy |
| 68815 | Probing, Nasolacrimal Duct, W/Wo Irrigation; W/Insertion, Tube/Stent | Colorado Prior Authorization List, Pg 83 Original policy |
| 69000 | Drainage Ext Ear, Abscess/Hematoma; Simple | Colorado Prior Authorization List, Pg 83 Original policy |
| 69090 | Ear Piercing | Colorado Prior Authorization List, Pg 83 Original policy |
| 69100 | Bx Ext Ear | Colorado Prior Authorization List, Pg 83 Original policy |
| 69110 | Excision Ext Ear; Partial, Simple Repair | Colorado Prior Authorization List, Pg 83 Original policy |
| 69140 | Excision Exostosis(Es), Ext Auditory Canal | Colorado Prior Authorization List, Pg 83 Original policy |
| 69145 | Excision Soft Tissue Lesion, Ext Auditory Canal | Colorado Prior Authorization List, Pg 84 Original policy |
| 69205 | Removal Fb, Ext Auditory Canal; W/General Anesthesia | Colorado Prior Authorization List, Pg 84 Original policy |
| 69222 | Debridement, Mastoidectomy Cavity, Complex | Colorado Prior Authorization List, Pg 84 Original policy |
| 69300 | Otoplasty, Protruding Ear, W/Wo Size Reduction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69310 | Reconstruction, Ext Auditory Canal (Sep Proc) | Colorado Prior Authorization List, Pg 84 Original policy |
| 69320 | Reconstruction, Ext Auditory Canal, Congenital Atresia, Single Stage | Colorado Prior Authorization List, Pg 84 Original policy |
| 69421 | Myringotomy W/Aspiration &/Or Eustachian Tube Inflation Requiring General Anesthesia | Colorado Prior Authorization List, Pg 84 Original policy |
| 69424 | Ventilating Tube Removal Requiring General Anesthesia | Colorado Prior Authorization List, Pg 84 Original policy |
| 69433 | Tympanostomy (Requiring Insertion, Ventilating Tube), Local/Topical Anesthesia | Colorado Prior Authorization List, Pg 84 Original policy |