Anthem Blue Cross Blue Shield of Colorado prior authorization, page 45
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 |
|---|---|---|
| 81560 | Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole p | Colorado Prior Authorization List, Pg 107 Original policy |
| 81595 | Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral b | Colorado Prior Authorization List, Pg 107 Original policy |
| 81596 | Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utiliz | Colorado Prior Authorization List, Pg 107 Original policy |
| 82233 | Beta-amyloid; 1-40 | Colorado Prior Authorization List, Pg 107 Original policy |
| 82234 | Beta-amyloid; 1-42 | Colorado Prior Authorization List, Pg 107 Original policy |
| 82542 | Column Chromatography/Mass Spectrometry; Quantitative, Single Stationary & Mobile Phase | Colorado Prior Authorization List, Pg 107 Original policy |
| 82787 | Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each | Colorado Prior Authorization List, Pg 107 Original policy |
| 83516 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitativ | Colorado Prior Authorization List, Pg 107 Original policy |
| 83520 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise sp | Colorado Prior Authorization List, Pg 107 Original policy |
| 83884 | Neurofilament light chain | Colorado Prior Authorization List, Pg 107 Original policy |
| 83921 | Organic Acid, Single, Quantitative | Colorado Prior Authorization List, Pg 107 Original policy |
| 84393 | Tau, phosphorylated | Colorado Prior Authorization List, Pg 107 Original policy |
| 84394 | Tau, total | Colorado Prior Authorization List, Pg 107 Original policy |
| 86001 | Allergen Specific Igg Quantitative/Semiquantitative, Ea Allergen | Colorado Prior Authorization List, Pg 107 Original policy |
| 86152 | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood) | Colorado Prior Authorization List, Pg 107 Original policy |
| 86153 | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required | Colorado Prior Authorization List, Pg 107 Original policy |
| 86343 | Leukocyte Histamine Release Test (Lhr) | Colorado Prior Authorization List, Pg 107 Original policy |
| 86352 | Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP) | Colorado Prior Authorization List, Pg 107 Original policy |
| 86357 | Natural killer (NK) cells, total count | Colorado Prior Authorization List, Pg 107 Original policy |
| 88356 | Morphometric Analysis; Nerve | Colorado Prior Authorization List, Pg 108 Original policy |
| 89329 | Sperm Evaluation; Hamster Penetration Test | Colorado Prior Authorization List, Pg 108 Original policy |
| 89330 | Sperm Evaluation; Cervical Mucus Penetration Test, W/Wo Spinnbarkeit Test | Colorado Prior Authorization List, Pg 108 Original policy |
| 90281 | Immune Globulin (Ig), Human, Im Use | Colorado Prior Authorization List, Pg 108 Original policy |
| 90283 | Immune Globulin (Igiv), Human, Iv Use | Colorado Prior Authorization List, Pg 108 Original policy |
| 90284 | Immune globulin (SCIg), human, for use in subcutaneous infusions, 100mg, each | Colorado Prior Authorization List, Pg 108 Original policy |
| 90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each | Colorado Prior Authorization List, Pg 108 Original policy |
| 90380 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use | Colorado Prior Authorization List, Pg 108 Original policy |
| 90381 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use | Colorado Prior Authorization List, Pg 108 Original policy |
| 90382 | Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 mL, for intramuscular use | Colorado Prior Authorization List, Pg 108 Original policy |
| 90867 | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management | Colorado Prior Authorization List, Pg 108 Original policy |
| 90868 | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session | Colorado Prior Authorization List, Pg 108 Original policy |
| 90869 | Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor Threshold Re-Determination With Delivery And Management | Colorado Prior Authorization List, Pg 108 Original policy |
| 90875 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Colorado Prior Authorization List, Pg 108 Original policy |
| 90876 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Colorado Prior Authorization List, Pg 108 Original policy |
| 90901 | Biofeedback Training, Any Modality | Colorado Prior Authorization List, Pg 108 Original policy |
| 90912 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qu | Colorado Prior Authorization List, Pg 108 Original policy |
| 90913 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on- one physician or | Colorado Prior Authorization List, Pg 108 Original policy |
| 91112 | Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report | Colorado Prior Authorization List, Pg 108 Original policy |
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | Colorado Prior Authorization List, Pg 108 Original policy |
| 92508 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals | Colorado Prior Authorization List, Pg 108 Original policy |
| 92521 | Evaluation of speech fluency (eg, stuttering, cluttering) | Colorado Prior Authorization List, Pg 108 Original policy |
| 92522 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) | Colorado Prior Authorization List, Pg 108 Original policy |
| 92523 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive an | Colorado Prior Authorization List, Pg 109 Original policy |
| 92524 | Behavioral and qualitative analysis of voice and resonance | Colorado Prior Authorization List, Pg 109 Original policy |
| 92526 | Treatment, Swallowing Dysfunction &/Or Oral Function, Feeding | Colorado Prior Authorization List, Pg 109 Original policy |
| 92605 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour | Colorado Prior Authorization List, Pg 109 Original policy |
| 92606 | Therapeutic Service(S), Use Non-Speech Generatiing Device, W/Programming & Modification | Colorado Prior Authorization List, Pg 109 Original policy |
| 92607 | Eval, Prescription, Speech-Generating Augmentative & Alternative Communication Device; 1st Hr | Colorado Prior Authorization List, Pg 109 Original policy |
| 92608 | Eval, Prescrip, Speech-Generating Augmentative & Alternative Communication Device; Ea Add'l 30 Min | Colorado Prior Authorization List, Pg 109 Original policy |
| 92609 | Therapeutic Services, Non-Speech Generative Device Use, W/Programming & Modification | Colorado Prior Authorization List, Pg 109 Original policy |