Anthem Blue Cross Blue Shield of Colorado prior authorization, page 59
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 |
|---|---|---|
| 0799T | Transcatheter removal of permanent dual-chamber leadless pacemaker,?including imaging guidance (e.g., fluoroscopy, venous ultrasound, right atrial angiography, right ventricul | Colorado Prior Authorization List, Pg 139 Original policy |
| 0800T | Transcatheter removal of permanent dual-chamber leadless pacemaker,?including imaging guidance (e.g., fluoroscopy, venous ultrasound, right atrial angiography, right ventricul | Colorado Prior Authorization List, Pg 139 Original policy |
| 0801T | Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging?guidance (e.g., fluoroscopy, venous ultrasound, right atrial angiography | Colorado Prior Authorization List, Pg 139 Original policy |
| 0802T | Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging?guidance (e.g., fluoroscopy, venous ultrasound, right atrial angiography | Colorado Prior Authorization List, Pg 139 Original policy |
| 0803T | Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging?guidance (e.g., fluoroscopy, venous ultrasound, right atrial angiography | Colorado Prior Authorization List, Pg 139 Original policy |
| 0810T | Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies | Colorado Prior Authorization List, Pg 139 Original policy |
| 0813T | Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of intragastric bariatric balloon | Colorado Prior Authorization List, Pg 139 Original policy |
| 0816T | Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, in | Colorado Prior Authorization List, Pg 139 Original policy |
| 0817T | Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, in | Colorado Prior Authorization List, Pg 139 Original policy |
| 0818T | Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subcut | Colorado Prior Authorization List, Pg 139 Original policy |
| 0819T | Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subfas | Colorado Prior Authorization List, Pg 139 Original policy |
| 0823T | Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography | Colorado Prior Authorization List, Pg 140 Original policy |
| 0824T | Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography an | Colorado Prior Authorization List, Pg 140 Original policy |
| 0825T | Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atria | Colorado Prior Authorization List, Pg 140 Original policy |
| 0861T | Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; both components (battery and transmitter) | Colorado Prior Authorization List, Pg 140 Original policy |
| 0862T | Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only | Colorado Prior Authorization List, Pg 140 Original policy |
| 0863T | Relocation of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; transmitter component only | Colorado Prior Authorization List, Pg 140 Original policy |
| 0864T | Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy | Colorado Prior Authorization List, Pg 140 Original policy |
| 0888T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance | Colorado Prior Authorization List, Pg 140 Original policy |
| 0894T | Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion | Colorado Prior Authorization List, Pg 140 Original policy |
| 0895T | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory a | Colorado Prior Authorization List, Pg 140 Original policy |
| 0908T | Open implantation of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed | Colorado Prior Authorization List, Pg 140 Original policy |
| 0909T | Replacement of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed | Colorado Prior Authorization List, Pg 140 Original policy |
| 0910T | Removal of integrated neurostimulation system, vagus nerve | Colorado Prior Authorization List, Pg 140 Original policy |
| 0911T | Electronic analysis of implanted integrated neurostimulation system, vagus nerve; without programming by physician or other qualified health care professional | Colorado Prior Authorization List, Pg 140 Original policy |
| 0912T | Electronic analysis of implanted integrated neurostimulation system, vagus nerve; with simple programming by physician or other qualified health care professional | Colorado Prior Authorization List, Pg 140 Original policy |
| 0913T | Percutaneous transcatheter therapeutic drug delivery by intracoronary drugdelivery balloon (eg, drug-coated, drug-eluting), including mechanical dilation by nondrug-delivery | Colorado Prior Authorization List, Pg 140 Original policy |
| 0915T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and ther | Colorado Prior Authorization List, Pg 140 Original policy |
| 0916T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and ther | Colorado Prior Authorization List, Pg 140 Original policy |
| 0917T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and ther | Colorado Prior Authorization List, Pg 140 Original policy |
| 0918T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and ther | Colorado Prior Authorization List, Pg 140 Original policy |
| 0919T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); pulse generator only | Colorado Prior Authorization List, Pg 140 Original policy |
| 0920T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous pacing lead only | Colorado Prior Authorization List, Pg 141 Original policy |
| 0921T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous defibrillation lead only | Colorado Prior Authorization List, Pg 141 Original policy |
| 0922T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); dual (pacing and defibrillation) transvenous leads only | Colorado Prior Authorization List, Pg 141 Original policy |
| 0923T | Removal and replacement of permanent cardiac contractility modulationdefibrillation pulse generator only | Colorado Prior Authorization List, Pg 141 Original policy |
| 0924T | Repositioning of previously implanted cardiac contractility modulation- defibrillation transvenous electrode(s)/lead(s), including fluoroscopic guidance and programming of sens | Colorado Prior Authorization List, Pg 141 Original policy |
| 0925T | Relocation of skin pocket for implanted cardiac contractility modulation- defibrillation pulse generator | Colorado Prior Authorization List, Pg 141 Original policy |
| 0926T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values | Colorado Prior Authorization List, Pg 141 Original policy |
| 0927T | Interrogation device evaluation (in person) with analysis, review, and report, including connection, recording, and disconnection, per patient encounter, implantable cardiac c | Colorado Prior Authorization List, Pg 141 Original policy |
| 0928T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system with interim analysis and report(s) by a physician or other qua | Colorado Prior Authorization List, Pg 141 Original policy |
| 0929T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system, remote data acquisition(s), receipt of transmissions, technici | Colorado Prior Authorization List, Pg 141 Original policy |
| 0930T | Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of se | Colorado Prior Authorization List, Pg 141 Original policy |
| 0931T | Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of se | Colorado Prior Authorization List, Pg 141 Original policy |
| 0933T | Transcatheter implantation of wireless left atrial pressure sensor for long-term left atrial pressure monitoring, including sensor calibration and deployment, right heart cath | Colorado Prior Authorization List, Pg 141 Original policy |
| 0934T | Remote monitoring of a wireless left atrial pressure sensor for up to 30 days, including data from daily uploads of left atrial pressure recordings, interpretation(s) and tren | Colorado Prior Authorization List, Pg 141 Original policy |
| 0935T | Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of u | Colorado Prior Authorization List, Pg 141 Original policy |
| 0948T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system with interim analysis, review and report(s) by a physician or other qualified | Colorado Prior Authorization List, Pg 141 Original policy |
| 0949T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation system, remote data acquisition(s), receipt of transmissions, technician review, tech | Colorado Prior Authorization List, Pg 141 Original policy |
| 0951T | Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor | Colorado Prior Authorization List, Pg 141 Original policy |