Anthem Blue Cross Blue Shield of Colorado prior authorization, page 47
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 |
|---|---|---|
| 93621 | Electrophys Eval, Insert Cath, W/Arrhyth Induction; W/Lt Atrial Pace/Record | Colorado Prior Authorization List, Pg 111 Original policy |
| 93622 | Electrophys Eval, Insert Cath, W/Arrythmia Induction; W/Lt Vent Pace/Record | Colorado Prior Authorization List, Pg 112 Original policy |
| 93624 | Electrophys, Follow-Up Study W/Pacing & Recording W/Arrhyth Induction | Colorado Prior Authorization List, Pg 112 Original policy |
| 93640 | Electrophys Eval, Single/Dual Pacing Cardio/Defib Leads, Initial Implant/Replace | Colorado Prior Authorization List, Pg 112 Original policy |
| 93641 | Electrophys Eval, Single/Dual Pacing Cardio/Defib Leads, Initial Implant/Replace; W/Pulse Generator | Colorado Prior Authorization List, Pg 112 Original policy |
| 93650 | Intracardiac Catheter Ablation, Atrioventricular Node Function/Conduction | Colorado Prior Authorization List, Pg 112 Original policy |
| 93653 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atri | Colorado Prior Authorization List, Pg 112 Original policy |
| 93654 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atri | Colorado Prior Authorization List, Pg 112 Original policy |
| 93656 | Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of | Colorado Prior Authorization List, Pg 112 Original policy |
| 93657 | Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolati | Colorado Prior Authorization List, Pg 112 Original policy |
| 93701 | Bioimpedance-derived physiologic cardiovascular analysis | Colorado Prior Authorization List, Pg 112 Original policy |
| 93880 | Duplex Scan, Extracranial Arteries; Complete Bilat Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93882 | Duplex Scan, Extracranial Arteries; Unilat/Limited Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93922 | Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior | Colorado Prior Authorization List, Pg 112 Original policy |
| 93923 | Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior | Colorado Prior Authorization List, Pg 112 Original policy |
| 93924 | Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing (ie, bidirectional Doppler waveform or volume plethysmography recor | Colorado Prior Authorization List, Pg 112 Original policy |
| 93925 | Duplex Scan, Lower Extremity Arteries/Arterial Bypass Grafts; Complete Bilat Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93926 | Duplex Scan, Lower Extremity Arteries/Arterial Bypass Grafts; Unilat/Limited Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93930 | Duplex Scan, Upper Extremity Arteries/Arterial Bypass Grafts; Complete Bilat Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93931 | Duplex Scan, Upper Extremity Arteries/Arterial Bypass Grafts; Unilat/Limited Study | Colorado Prior Authorization List, Pg 112 Original policy |
| 93978 | Duplex Scan, Aorta, Inferior Vena Cava, Iliac Vasculature/Bypass Grafts; Complete Study | Colorado Prior Authorization List, Pg 113 Original policy |
| 93979 | Duplex Scan, Aorta, Inferior Vena Cava, Iliac Vasculature/Bypass Grafts; Unilat/Limited | Colorado Prior Authorization List, Pg 113 Original policy |
| 94667 | Chest Wall Manipulation, Facilitate Lung Function; Initial Demo &/Or Eval | Colorado Prior Authorization List, Pg 113 Original policy |
| 94668 | Chest Wall Manipulation, Facilitate Lung Function; Subsequent | Colorado Prior Authorization List, Pg 113 Original policy |
| 95782 | Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist | Colorado Prior Authorization List, Pg 113 Original policy |
| 95783 | Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level | Colorado Prior Authorization List, Pg 113 Original policy |
| 95800 | Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time | Colorado Prior Authorization List, Pg 113 Original policy |
| 95801 | Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (eg, by airflow or peripheral arterial tone) | Colorado Prior Authorization List, Pg 113 Original policy |
| 95805 | Multiple Sleep Latency Test, Multiple Trails | Colorado Prior Authorization List, Pg 113 Original policy |
| 95806 | Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory | Colorado Prior Authorization List, Pg 113 Original policy |
| 95807 | Sleep Study, Attended | Colorado Prior Authorization List, Pg 113 Original policy |
| 95808 | Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist | Colorado Prior Authorization List, Pg 113 Original policy |
| 95810 | Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist | Colorado Prior Authorization List, Pg 113 Original policy |
| 95811 | Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel v | Colorado Prior Authorization List, Pg 113 Original policy |
| 95905 | Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, eac | Colorado Prior Authorization List, Pg 113 Original policy |
| 95921 | Testing, Autonomic Nervous System; Cardiovagal Innervation Parasympathetic | Colorado Prior Authorization List, Pg 113 Original policy |
| 95923 | Testing, Autonomic Nervous System; Sudomotor | Colorado Prior Authorization List, Pg 113 Original policy |
| 95965 | Magnetoencephalography (Meg), Record & Analysis; For Spontaneous Brain Magnetic Activity | Colorado Prior Authorization List, Pg 113 Original policy |
| 95966 | Magnetoencephalography (Meg), Record & Analysis; For Evoked Magnetic Fields, Single Modality | Colorado Prior Authorization List, Pg 113 Original policy |
| 95976 | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst | Colorado Prior Authorization List, Pg 113 Original policy |
| 95977 | Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst | Colorado Prior Authorization List, Pg 113 Original policy |
| 96001 | Comprehensive computer-based motion analysis by video-taping and 3D kinematics; with dynamic plantar pressure measuremen | Colorado Prior Authorization List, Pg 113 Original policy |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | Colorado Prior Authorization List, Pg 113 Original policy |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | Colorado Prior Authorization List, Pg 113 Original policy |
| 96904 | Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history o | Colorado Prior Authorization List, Pg 113 Original policy |
| 96931 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion | Colorado Prior Authorization List, Pg 113 Original policy |
| 96932 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion | Colorado Prior Authorization List, Pg 113 Original policy |
| 96933 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion | Colorado Prior Authorization List, Pg 114 Original policy |
| 96934 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, each additional lesion (List separately i | Colorado Prior Authorization List, Pg 114 Original policy |
| 96935 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (List separately in addition to code for pr | Colorado Prior Authorization List, Pg 114 Original policy |