Anthem Blue Cross Blue Shield of Colorado prior authorization, page 37
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 |
|---|---|---|
| 72193 | Ct Scan, Pelvis; W/Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72194 | Ct Scan, Pelvis; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 88 Original policy |
| 72195 | Mri, Pelvis; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 88 Original policy |
| 72196 | Mri, Pelvis; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 88 Original policy |
| 72197 | Mri, Pelvis; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Colorado Prior Authorization List, Pg 88 Original policy |
| 72198 | Mra, Pelvis, W/Wo Contrast | Colorado Prior Authorization List, Pg 88 Original policy |
| 72285 | Discography, cervical or thoracic, radiological supervision and interpretation | Colorado Prior Authorization List, Pg 89 Original policy |
| 72295 | Discography, lumbar, radiological supervision and interpretation | Colorado Prior Authorization List, Pg 89 Original policy |
| 73200 | Ct Scan, Upper Extremity; W/O Contrast | Colorado Prior Authorization List, Pg 89 Original policy |
| 73201 | Ct Scan, Upper Extremity; W/Contrast | Colorado Prior Authorization List, Pg 89 Original policy |
| 73202 | Ct Scan, Upper Extremity; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 89 Original policy |
| 73206 | Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed | Colorado Prior Authorization List, Pg 89 Original policy |
| 73218 | Mri, Upper Extremity, Other Than Joint; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73219 | Mri, Upper Extremity, Other Than Joint; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73220 | Mri, Upper Extremity, Other Than Joint; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Sequenc | Colorado Prior Authorization List, Pg 89 Original policy |
| 73221 | Mri, Any Joint, Upper Extremity; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73222 | Mri, Any Joint, Upper Extremity; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73223 | Mri, Any Joint Of Upper Extremity; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequ | Colorado Prior Authorization List, Pg 89 Original policy |
| 73225 | Mra, Upper Extremity, W/Wo Contrast | Colorado Prior Authorization List, Pg 89 Original policy |
| 73700 | Ct Scan, Lower Extremity; W/O Contrast | Colorado Prior Authorization List, Pg 89 Original policy |
| 73701 | Ct Scan, Lower Extremity; W/Contrast | Colorado Prior Authorization List, Pg 89 Original policy |
| 73702 | Ct Scan, Lower Extremity; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 89 Original policy |
| 73706 | Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed | Colorado Prior Authorization List, Pg 89 Original policy |
| 73718 | Mri, Lower Extremity Other Than Joint; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73719 | Mri, Lower Extremity Other Than Joint; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73720 | Mri, Lower Extremity, Other Than Joint; W/O Contrast Matl(S), Followed Contrast Matl(S) & Furthr Seq | Colorado Prior Authorization List, Pg 89 Original policy |
| 73721 | Mri, Any Joint, Lower Extremity; W/O Contrast Matl | Colorado Prior Authorization List, Pg 89 Original policy |
| 73722 | Mri, Any Joint, Lower Extremity; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 89 Original policy |
| 73723 | Mri, Any Joint, Lower Extremity; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Seq | Colorado Prior Authorization List, Pg 89 Original policy |
| 73725 | Mra, Lower Extremity, W/Wo Contrast | Colorado Prior Authorization List, Pg 90 Original policy |
| 74150 | Ct Scan, Abdomen; W/O Contrast | Colorado Prior Authorization List, Pg 90 Original policy |
| 74160 | Computed tomography, abdomen; with contrast material(s) | Colorado Prior Authorization List, Pg 90 Original policy |
| 74170 | Ct Scan, Abdomen; W/O Contrast, Then W/Contrast & Further Sections | Colorado Prior Authorization List, Pg 90 Original policy |
| 74174 | Computed Tomographic Angiography, Abdomen And Pelvis, With Contrast Material(S), Including Noncontrast Images, If Performed, And Image Postprocessing | Colorado Prior Authorization List, Pg 90 Original policy |
| 74175 | Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and im | Colorado Prior Authorization List, Pg 90 Original policy |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | Colorado Prior Authorization List, Pg 90 Original policy |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material(s) | Colorado Prior Authorization List, Pg 90 Original policy |
| 74178 | Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regio | Colorado Prior Authorization List, Pg 90 Original policy |
| 74181 | Mri, Abdomen; W/O Contrast Matl(S) | Colorado Prior Authorization List, Pg 90 Original policy |
| 74182 | Mri, Abdomen; W/Contrast Matl(S) | Colorado Prior Authorization List, Pg 90 Original policy |
| 74183 | Mri, Abdomen; W/O Contrast Matl(S) Followed By Contrast Matl(S) & Further Sequences | Colorado Prior Authorization List, Pg 90 Original policy |
| 74185 | Mra, Abdomen, W/Wo Contrast | Colorado Prior Authorization List, Pg 90 Original policy |
| 74261 | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material | Colorado Prior Authorization List, Pg 90 Original policy |
| 74262 | Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including | Colorado Prior Authorization List, Pg 90 Original policy |
| 74263 | Computed tomographic (CT) colonography, screening, including image postprocessing | Colorado Prior Authorization List, Pg 90 Original policy |
| 74712 | Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single of first gestation | Colorado Prior Authorization List, Pg 90 Original policy |
| 75557 | Cardiac magnetic resonance imaging for morphology and function without contrast material | Colorado Prior Authorization List, Pg 90 Original policy |
| 75559 | Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging | Colorado Prior Authorization List, Pg 90 Original policy |
| 75561 | Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast materi | Colorado Prior Authorization List, Pg 90 Original policy |
| 75563 | Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast materi | Colorado Prior Authorization List, Pg 91 Original policy |