Anthem Blue Cross Blue Shield of Colorado prior authorization, page 48
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 |
|---|---|---|
| 96936 | Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (List separately in addition to cod | Colorado Prior Authorization List, Pg 114 Original policy |
| 97010 | Application of a modality to 1 or more areas; hot or cold packs | Colorado Prior Authorization List, Pg 114 Original policy |
| 97012 | Application of a modality to 1 or more areas; traction, mechanical | Colorado Prior Authorization List, Pg 114 Original policy |
| 97014 | Application of a modality to 1 or more areas; electrical stimulation (unattended) | Colorado Prior Authorization List, Pg 114 Original policy |
| 97016 | Application of a modality to 1 or more areas; vasopneumatic devices | Colorado Prior Authorization List, Pg 114 Original policy |
| 97018 | Application of a modality to 1 or more areas; paraffin bath | Colorado Prior Authorization List, Pg 114 Original policy |
| 97022 | Application of a modality to 1 or more areas; whirlpool | Colorado Prior Authorization List, Pg 114 Original policy |
| 97024 | Application of a modality to 1 or more areas; diathermy (eg, microwave) | Colorado Prior Authorization List, Pg 114 Original policy |
| 97026 | Application of a modality to 1 or more areas; infrared | Colorado Prior Authorization List, Pg 114 Original policy |
| 97028 | Application of a modality to 1 or more areas; ultraviolet | Colorado Prior Authorization List, Pg 114 Original policy |
| 97032 | Application, Modality 1+ Areas; Electrical Stimulation (Manual), Each 15 Min | Colorado Prior Authorization List, Pg 114 Original policy |
| 97033 | Application of a modality to 1 or more areas; iontophoresis, each 15 minutes | Colorado Prior Authorization List, Pg 114 Original policy |
| 97034 | Application, Modality To 1+ Areas; Contrast Baths, Each 15 Min | Colorado Prior Authorization List, Pg 114 Original policy |
| 97035 | Application, Modality To 1+ Areas; Ultrasound, Each 15 Min | Colorado Prior Authorization List, Pg 114 Original policy |
| 97036 | Application, Modality To 1+ Areas; Hubbard Tank, Each 15 Min | Colorado Prior Authorization List, Pg 115 Original policy |
| 97110 | Therapeutic Proc, 1+ Areas, Each 15 Min; Therapeutic Exercises | Colorado Prior Authorization List, Pg 115 Original policy |
| 97112 | Therapeutic Proc, 1+ Areas, Each 15 Min; Neuromuscular Reeducation | Colorado Prior Authorization List, Pg 115 Original policy |
| 97113 | Therapeutic Proc, 1+ Areas, Each 15 Min; Aquatic Therapy W/Exercises | Colorado Prior Authorization List, Pg 115 Original policy |
| 97116 | Therapeutic Proc, 1+ Areas, Each 15 Min; Gait Training (W/Stair Climbing) | Colorado Prior Authorization List, Pg 115 Original policy |
| 97124 | Therapeutic Proc, 1+ Areas, Each 15 Min; Massage | Colorado Prior Authorization List, Pg 115 Original policy |
| 97129 | Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensato | Colorado Prior Authorization List, Pg 115 Original policy |
| 97130 | Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensato | Colorado Prior Authorization List, Pg 115 Original policy |
| 97140 | Manual Therapy Techniques, 1+ Regions, Each 15 Min | Colorado Prior Authorization List, Pg 115 Original policy |
| 97150 | Therapeutic Proc(S), Group, (2+ Individuals) | Colorado Prior Authorization List, Pg 115 Original policy |
| 97161 | Physical therapy evaluation; low complexity, requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97162 | Physical therapy evaluation; moderate complexity requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97163 | Physical therapy evaluation; high complexity requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97164 | Reevaluation of physical therapy established plan of care requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97165 | Occupational therapy evaluation; low complexity requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97166 | Occupational therapy evaluation; moderate complexity requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97167 | Occupational therapy evaluation; high complexity requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97168 | Reevaluation of occupational therapy care/established plan of care requiring components | Colorado Prior Authorization List, Pg 115 Original policy |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | Colorado Prior Authorization List, Pg 116 Original policy |
| 97533 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes | Colorado Prior Authorization List, Pg 116 Original policy |
| 97535 | Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive t | Colorado Prior Authorization List, Pg 116 Original policy |
| 97537 | Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis | Colorado Prior Authorization List, Pg 116 Original policy |
| 97542 | Wheelchair management (eg, assessment, fitting, training), each 15 minutes | Colorado Prior Authorization List, Pg 116 Original policy |
| 97545 | Work Hardening/Conditioning; Initial 2 Hours | Colorado Prior Authorization List, Pg 116 Original policy |
| 97546 | Work Hardening/Conditioning; Add'l Hr | Colorado Prior Authorization List, Pg 116 Original policy |
| 97610 | Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day | Colorado Prior Authorization List, Pg 116 Original policy |
| 97750 | Physical Performance Test, W/Written Report, Each 15 Min | Colorado Prior Authorization List, Pg 116 Original policy |
| 97755 | Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct on | Colorado Prior Authorization List, Pg 116 Original policy |
| 97760 | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s | Colorado Prior Authorization List, Pg 116 Original policy |
| 97761 | Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes | Colorado Prior Authorization List, Pg 116 Original policy |
| 97763 | Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes | Colorado Prior Authorization List, Pg 116 Original policy |
| 99151 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation suppor | Colorado Prior Authorization List, Pg 116 Original policy |
| 99152 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation suppor | Colorado Prior Authorization List, Pg 116 Original policy |
| 99155 | Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing | Colorado Prior Authorization List, Pg 116 Original policy |
| 99156 | Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing | Colorado Prior Authorization List, Pg 116 Original policy |
| 99183 | Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session | Colorado Prior Authorization List, Pg 117 Original policy |