Anthem Blue Cross Blue Shield of Colorado prior authorization, page 35
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 |
|---|---|---|
| 69436 | Tympanostomy (Requiring Insertion, Ventilating Tube), General Anesthesia | Colorado Prior Authorization List, Pg 84 Original policy |
| 69440 | Middle Ear Exploration Through Postauricular/Ear Canal Incision | Colorado Prior Authorization List, Pg 84 Original policy |
| 69450 | Tympanolysis, Transcanal | Colorado Prior Authorization List, Pg 84 Original policy |
| 69502 | Mastoidectomy; Complete | Colorado Prior Authorization List, Pg 84 Original policy |
| 69505 | Mastoidectomy; Modified Radical | Colorado Prior Authorization List, Pg 84 Original policy |
| 69550 | Excision Aural Glomus Tumor; Transcanal | Colorado Prior Authorization List, Pg 84 Original policy |
| 69602 | Revision Mastoidectomy; Resulting In Modified Radical Mastoidectomy | Colorado Prior Authorization List, Pg 84 Original policy |
| 69610 | Tympanic Membrane Repair, W/Wo Site Preparation/Perforation, W/Wo Patch | Colorado Prior Authorization List, Pg 84 Original policy |
| 69620 | Myringoplasty (Surgery Confined To Drumhead & Donor Area) | Colorado Prior Authorization List, Pg 84 Original policy |
| 69631 | Tympanoplasty W/O Mastoidectomy Initial/Revision; W/O Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69632 | Tympanoplasty W/O Mastoidectomy Initial/Revision; W/Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69633 | Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision | Colorado Prior Authorization List, Pg 84 Original policy |
| 69635 | Tympanoplasty W/Antrotomy/Mastoidotomy; W/O Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69636 | Tympanoplasty W/Antrotomy/Mastoidotomy; W/Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69641 | Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69642 | Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction | Colorado Prior Authorization List, Pg 84 Original policy |
| 69643 | Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction, Intact Wall | Colorado Prior Authorization List, Pg 84 Original policy |
| 69644 | Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction, Intact Wall | Colorado Prior Authorization List, Pg 84 Original policy |
| 69645 | Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction, Radical | Colorado Prior Authorization List, Pg 84 Original policy |
| 69646 | Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction, Radical | Colorado Prior Authorization List, Pg 84 Original policy |
| 69650 | Stapes Mobilization | Colorado Prior Authorization List, Pg 84 Original policy |
| 69660 | Stabedectomy/Stapedotomy, W/Wo Foreign Matl | Colorado Prior Authorization List, Pg 84 Original policy |
| 69661 | Stabedectomy/Stapedotomy W/Wo Foreign Matl; W/Footplate Drill Out | Colorado Prior Authorization List, Pg 84 Original policy |
| 69662 | Revision, Stapedectomy/Stapedotomy | Colorado Prior Authorization List, Pg 85 Original policy |
| 69666 | Repair Oval Window Fistula | Colorado Prior Authorization List, Pg 85 Original policy |
| 69705 | Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral | Colorado Prior Authorization List, Pg 85 Original policy |
| 69706 | Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral | Colorado Prior Authorization List, Pg 85 Original policy |
| 69710 | Implantation/Replacement, Electromagnetic Bone Conduction Hearing Device, Temporal Bone | Colorado Prior Authorization List, Pg 85 Original policy |
| 69714 | Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor | Colorado Prior Authorization List, Pg 85 Original policy |
| 69715 | Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy | Colorado Prior Authorization List, Pg 85 Original policy |
| 69716 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than | Colorado Prior Authorization List, Pg 85 Original policy |
| 69717 | Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor | Colorado Prior Authorization List, Pg 85 Original policy |
| 69718 | Replacement, Osseointegrated Implant, Temporal Bone; W/Mastoidectomy | Colorado Prior Authorization List, Pg 85 Original policy |
| 69719 | Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid an | Colorado Prior Authorization List, Pg 85 Original policy |
| 69729 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater | Colorado Prior Authorization List, Pg 85 Original policy |
| 69730 | Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid a | Colorado Prior Authorization List, Pg 85 Original policy |
| 69801 | Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal | Colorado Prior Authorization List, Pg 85 Original policy |
| 69805 | Endolymphatic Sac Operation; W/O Shunt | Colorado Prior Authorization List, Pg 85 Original policy |
| 69806 | Endolymphatic Sac Operation; W/Shunt | Colorado Prior Authorization List, Pg 85 Original policy |
| 69930 | Cochlear Device Implantation, W/Wo Mastoidectomy | Colorado Prior Authorization List, Pg 85 Original policy |
| 69955 | Total Facial Nerve Decompression &/Or Repair, (May Include Graft) | Colorado Prior Authorization List, Pg 85 Original policy |
| 70336 | Mri, Temporomandibular Joints | Colorado Prior Authorization List, Pg 85 Original policy |
| 70450 | Ct Scan, Head/Brain; W/O Contrast Matl | Colorado Prior Authorization List, Pg 85 Original policy |
| 70460 | Ct Scan, Head/Brain; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 85 Original policy |
| 70470 | Ct Scan, Head/Brain; W/O Contrast, Then W/Contrast | Colorado Prior Authorization List, Pg 85 Original policy |
| 70480 | Ct Scan, Orbit/Sella/Posterior Fossa/Outer, Middle, Inner Ear; W/O Contrast | Colorado Prior Authorization List, Pg 85 Original policy |
| 70481 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/Contrast | Colorado Prior Authorization List, Pg 86 Original policy |
| 70482 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/O Contrast, Then W/Contrast | Colorado Prior Authorization List, Pg 86 Original policy |
| 70486 | Ct Scan, Maxillofacial Area; W/O Contrast Matl | Colorado Prior Authorization List, Pg 86 Original policy |
| 70487 | Ct Scan, Maxillofacial Area; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |