Anthem Blue Cross Blue Shield of Colorado prior authorization, page 36
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 |
|---|---|---|
| 70488 | Ct Scan, Maxillofacial Area; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 86 Original policy |
| 70490 | Ct Scan, Soft Tissue Neck; W/O Contrast Matl | Colorado Prior Authorization List, Pg 86 Original policy |
| 70491 | Ct Scan, Soft Tissue Neck; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70492 | Ct Scan, Neck Tissue; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 86 Original policy |
| 70496 | Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing | Colorado Prior Authorization List, Pg 86 Original policy |
| 70498 | Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | Colorado Prior Authorization List, Pg 86 Original policy |
| 70540 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70542 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70543 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast ma | Colorado Prior Authorization List, Pg 86 Original policy |
| 70544 | Mra, Head; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70545 | Mra, Head; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70546 | Mra, Head; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Colorado Prior Authorization List, Pg 86 Original policy |
| 70547 | Mra, Neck; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70548 | Mra, Neck; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 86 Original policy |
| 70549 | Mra, Neck; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Colorado Prior Authorization List, Pg 86 Original policy |
| 70551 | Mri, Brain; W/O Contrast | Colorado Prior Authorization List, Pg 86 Original policy |
| 70552 | Mri, Brain; W/Contrast | Colorado Prior Authorization List, Pg 87 Original policy |
| 70553 | Mri, Brain; W/O Contrast, Then W/Contrast & Further Sequences | Colorado Prior Authorization List, Pg 87 Original policy |
| 70554 | Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part m | Colorado Prior Authorization List, Pg 87 Original policy |
| 70555 | Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofun | Colorado Prior Authorization List, Pg 87 Original policy |
| 71250 | Computed tomography, thorax, diagnostic; without contrast material | Colorado Prior Authorization List, Pg 87 Original policy |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material(s) | Colorado Prior Authorization List, Pg 87 Original policy |
| 71270 | Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections | Colorado Prior Authorization List, Pg 87 Original policy |
| 71271 | Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) | Colorado Prior Authorization List, Pg 87 Original policy |
| 71275 | Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if perfo | Colorado Prior Authorization List, Pg 87 Original policy |
| 71550 | Mri, Chest; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 87 Original policy |
| 71551 | Mri, Chest; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 87 Original policy |
| 71552 | Mri, Chest; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Colorado Prior Authorization List, Pg 87 Original policy |
| 71555 | Mra, Chest (Exclude Myocardium), W/Wo Contrast Matl(S) | Colorado Prior Authorization List, Pg 87 Original policy |
| 72125 | Ct Scan, Cervical Spine; W/O Contrast | Colorado Prior Authorization List, Pg 87 Original policy |
| 72126 | Ct Scan, Cervical Spine; W/Contrast | Colorado Prior Authorization List, Pg 87 Original policy |
| 72127 | Ct Scan, Cervical Spine; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 87 Original policy |
| 72128 | Computed tomography, thoracic spine; without contrast material | Colorado Prior Authorization List, Pg 87 Original policy |
| 72129 | Cat,Thoracic Spine;w/Contrst Materl,18-2 | Colorado Prior Authorization List, Pg 87 Original policy |
| 72130 | Ct Scan, Thoracic Spine; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 87 Original policy |
| 72131 | Ct Scan, Lumbar Spine; W/O Contrast | Colorado Prior Authorization List, Pg 87 Original policy |
| 72132 | Ct Scan, Lumbar Spine; W/Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72133 | Ct Scan, Lumbar Spine; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 88 Original policy |
| 72141 | Mri, Cervical Spine; W/O Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72142 | Mri, Cervical Spine; W/Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72146 | Mri, Thoracic Spine; W/O Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72147 | Mri, Thoracic Spine; W/Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72148 | Mri, Lumbar Spine; W/O Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72149 | Mri, Lumbar Spine; W/Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72156 | Mri, Spine W/O Contrast, Then W/Contrast; Cervical | Colorado Prior Authorization List, Pg 88 Original policy |
| 72157 | Mri, Spine W/O Contrast, Then W/Contrast; Thoracic | Colorado Prior Authorization List, Pg 88 Original policy |
| 72158 | Mri, Spine W/O Contrast, Then W/Contrast; Lumbar | Colorado Prior Authorization List, Pg 88 Original policy |
| 72159 | Mra, Spine W/Wo Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72191 | Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and ima | Colorado Prior Authorization List, Pg 88 Original policy |
| 72192 | Ct Scan, Pelvis; W/O Contrast | Colorado Prior Authorization List, Pg 88 Original policy |