Anthem Blue Cross Blue Shield of Colorado prior authorization, page 57
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 |
|---|---|---|
| 0536U | Red blood cell antigen (fetal RhD), PCR analysis of exon 4 of RHD gene and housekeeping control gene GAPDH from whole blood in pregnant individuals at 10+ weeks gestation know | Colorado Prior Authorization List, Pg 134 Original policy |
| 0537U | Oncology (colorectal cancer), analysis of cell-free DNA for epigenomic patterns, next-generation sequencing, >2500 differentially methylated regions (DMRs), plasma, algorithm | Colorado Prior Authorization List, Pg 135 Original policy |
| 0538U | Oncology (solid tumor), next-generation targeted sequencing analysis, formalin- fixed paraffin-embedded (FFPE) tumor tissue, DNA analysis of 600 genes, interrogation for single | Colorado Prior Authorization List, Pg 135 Original policy |
| 0539U | Oncology (solid tumor), cell-free circulating tumor DNA (ctDNA), 152 genes, next- generation sequencing, interrogation for single-nucleotide variants, insertions/deletions, gen | Colorado Prior Authorization List, Pg 135 Original policy |
| 0540U | Transplantation medicine, quantification of donor-derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor- derived cell-free | Colorado Prior Authorization List, Pg 135 Original policy |
| 0543U | Oncology (solid tumor), next-generation sequencing of DNA from formalin-fixed paraffin-embedded (FFPE) tissue of 517 genes, interrogation for single- nucleotide variants, multi | Colorado Prior Authorization List, Pg 135 Original policy |
| 0544T | Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture | Colorado Prior Authorization List, Pg 135 Original policy |
| 0545T | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach | Colorado Prior Authorization List, Pg 135 Original policy |
| 0546T | Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report | Colorado Prior Authorization List, Pg 135 Original policy |
| 0547U | Neurofilament light chain (NfL), chemiluminescent enzyme immunoassay, plasma, quantitative | Colorado Prior Authorization List, Pg 135 Original policy |
| 0549U | Oncology (urothelial), DNA, quantitative methylated real-time PCR of TRNA-Cys, SIM2, and NKX1-1, using urine, diagnostic algorithm reported as a probability index for bladder | Colorado Prior Authorization List, Pg 135 Original policy |
| 0552T | Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional | Colorado Prior Authorization List, Pg 135 Original policy |
| 0552U | Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease-causing locus, and when | Colorado Prior Authorization List, Pg 135 Original policy |
| 0553U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrang | Colorado Prior Authorization List, Pg 135 Original policy |
| 0554U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a | Colorado Prior Authorization List, Pg 135 Original policy |
| 0555U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrang | Colorado Prior Authorization List, Pg 135 Original policy |
| 0560U | Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell- free DNA, whole blood and tumor tissue, baseline assessment for design and construction of a persona | Colorado Prior Authorization List, Pg 135 Original policy |
| 0561U | Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell- free DNA, whole blood, subsequent assessment with comparison to initial assessment to evaluate for M | Colorado Prior Authorization List, Pg 135 Original policy |
| 0562U | Oncology (solid tumor), targeted genomic sequence analysis, 33 genes, detection of single-nucleotide variants (SNVs), insertions and deletions, copy- number amplifications, and | Colorado Prior Authorization List, Pg 135 Original policy |
| 0563T | Evacuation of meibomian glands, using heat delivered through wearable, open- eye eyelid treatment devices and manual gland expression, bilateral | Colorado Prior Authorization List, Pg 135 Original policy |
| 0565T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation | Colorado Prior Authorization List, Pg 135 Original policy |
| 0565U | Oncology (hepatocellular carcinoma), next-generation sequencing methylation pattern assay to detect 6626 epigenetic alterations, cell-free DNA, plasma, algorithm reported as c | Colorado Prior Authorization List, Pg 135 Original policy |
| 0566T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound gu | Colorado Prior Authorization List, Pg 136 Original policy |
| 0566U | Oncology (lung), qPCR-based analysis of 13 differentially methylated regions (CCDC181, HOXA7, LRRC8A, MARCHF11, MIR129-2, NCOR2, PANTR1, PRKCB, SLC9A3, TBR1_2, TRAP1, VWC2, ZN | Colorado Prior Authorization List, Pg 136 Original policy |
| 0567U | Rare diseases (constitutional/heritable disorders), whole-genome sequence analysis combination of short and long reads, for single-nucleotide variants, insertions/deletions an | Colorado Prior Authorization List, Pg 136 Original policy |
| 0568U | Neurology (dementia), beta amyloid (AB40, AB42, AB42/40 ratio), tau-protein phosphorylated at residue (eg, pTau217), neurofilament light chain (NfL), and glial fibrillary acid | Colorado Prior Authorization List, Pg 136 Original policy |
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | Colorado Prior Authorization List, Pg 136 Original policy |
| 0569U | Oncology (solid tumor), next-generation sequencing analysis of tumor methylation markers (>20000 differentially methylated regions) present in cell- free circulating tumor DNA | Colorado Prior Authorization List, Pg 136 Original policy |
| 0571U | Oncology (solid tumor), DNA (80 genes) and RNA (10 genes), by next-generation sequencing, plasma, including single-nucleotide variants, insertions/deletions, copy-number alter | Colorado Prior Authorization List, Pg 136 Original policy |
| 0580T | Removal of substernal implantable defibrillator pulse generator only | Colorado Prior Authorization List, Pg 136 Original policy |
| 0581T | Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral | Colorado Prior Authorization List, Pg 136 Original policy |
| 0584T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when perf | Colorado Prior Authorization List, Pg 136 Original policy |
| 0585T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when perf | Colorado Prior Authorization List, Pg 136 Original policy |
| 0586T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when perf | Colorado Prior Authorization List, Pg 136 Original policy |
| 0587T | Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator | Colorado Prior Authorization List, Pg 136 Original policy |
| 0588T | Revision or removal of percutaneously placed integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator | Colorado Prior Authorization List, Pg 136 Original policy |
| 0589U | Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 24 PFAS compounds by high-performance liquid chromatography with tandem mass spec | Colorado Prior Authorization List, Pg 136 Original policy |
| 0596T | Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement | Colorado Prior Authorization List, Pg 136 Original policy |
| 0597T | Temporary female intraurethral valve-pump (ie, voiding prosthesis); replacement | Colorado Prior Authorization List, Pg 136 Original policy |
| 0600T | Ablation, irreversible electroporation; 1 or more tumors per organ, other than liver or prostate, including imaging guidance, when performed, percutaneous | Colorado Prior Authorization List, Pg 136 Original policy |
| 0601T | Ablation, irreversible electroporation; 1 or more tumors per organ, including fluoroscopic and ultrasound guidance, when performed, open | Colorado Prior Authorization List, Pg 136 Original policy |
| 0607T | Remote monitoring of an external continuous pulmonary fluid monitoring system, including measurement of radiofrequency-derived pulmonary fluid levels, heart rate, respiration | Colorado Prior Authorization List, Pg 136 Original policy |
| 0608T | Remote monitoring of an external continuous pulmonary fluid monitoring system, including measurement of radiofrequency-derived pulmonary fluid levels, heart rate, respiration | Colorado Prior Authorization List, Pg 136 Original policy |
| 0615T | Automated analysis of binocular eye movements without spatial calibration, including disconjugacy, saccades, and pupillary dynamics for the assessment of concussion, with inte | Colorado Prior Authorization List, Pg 136 Original policy |
| 0620T | Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or | Colorado Prior Authorization List, Pg 137 Original policy |
| 0627T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first le | Colorado Prior Authorization List, Pg 137 Original policy |
| 0629T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level | Colorado Prior Authorization List, Pg 137 Original policy |
| 0633T | Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material | Colorado Prior Authorization List, Pg 137 Original policy |
| 0634T | Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) | Colorado Prior Authorization List, Pg 137 Original policy |
| 0635T | Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s) | Colorado Prior Authorization List, Pg 137 Original policy |