Anthem Blue Cross Blue Shield of Colorado prior authorization, page 62
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 |
|---|---|---|
| B4220 | Parenteral Supply Kit Premix | Colorado Prior Authorization List, Pg 144 Original policy |
| B4222 | Parenteral Supply Kit Homemi | Colorado Prior Authorization List, Pg 144 Original policy |
| B4224 | Parenteral Administration Ki | Colorado Prior Authorization List, Pg 144 Original policy |
| B5000 | Parenteral Sol Renal-Amirosy | Colorado Prior Authorization List, Pg 144 Original policy |
| B5100 | Parenteral Sol Hepatic-Fream | Colorado Prior Authorization List, Pg 144 Original policy |
| B5200 | Parenteral Sol Stres-Brnch C | Colorado Prior Authorization List, Pg 144 Original policy |
| B9004 | Parenteral Infus Pump Portab | Colorado Prior Authorization List, Pg 144 Original policy |
| B9006 | Parenteral Infus Pump Statio | Colorado Prior Authorization List, Pg 144 Original policy |
| C1605 | Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation | Colorado Prior Authorization List, Pg 144 Original policy |
| C1721 | Cardioverter-defibrillator, dual chamber (implantable) | Colorado Prior Authorization List, Pg 144 Original policy |
| C1722 | Cardioverter-defibrillator, single chamber (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1726 | Catheter, balloon dilatation, nonvascular | Colorado Prior Authorization List, Pg 145 Original policy |
| C1734 | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1735 | Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components | Colorado Prior Authorization List, Pg 145 Original policy |
| C1736 | Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components | Colorado Prior Authorization List, Pg 145 Original policy |
| C1763 | Connective tissue, nonhuman (includes synthetic) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1764 | Event recorder, cardiac (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1767 | Generator, neurostimulator (implantable), nonrechargeable | Colorado Prior Authorization List, Pg 145 Original policy |
| C1772 | Infusion pump, programmable (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1777 | Lead, cardioverter-defibrillator, endocardial single coil (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1778 | Lead, neurostimulator (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1785 | Pacemaker, dual chamber, rate-responsive (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1786 | Pacemaker, single chamber, rate-responsive (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1787 | Patient programmer, neurostimulator | Colorado Prior Authorization List, Pg 145 Original policy |
| C1789 | Prosthesis, breast (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1813 | Prosthesis, penile, inflatable | Colorado Prior Authorization List, Pg 145 Original policy |
| C1815 | Prosthesis, urinary sphincter (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1816 | Receiver and/or transmitter, neurostimulator (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1820 | Generator, neurostimulator (implantable), with rechargeable battery and charging system | Colorado Prior Authorization List, Pg 145 Original policy |
| C1821 | Interspinous process distraction device (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1822 | Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system | Colorado Prior Authorization List, Pg 145 Original policy |
| C1823 | Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads | Colorado Prior Authorization List, Pg 145 Original policy |
| C1824 | Generator, cardiac contractility modulation (implantable) | Colorado Prior Authorization List, Pg 145 Original policy |
| C1825 | Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1832 | Autograft suspension, including cell processing and application, and all system components | Colorado Prior Authorization List, Pg 146 Original policy |
| C1833 | Monitor, cardiac, including intracardiac lead and all system components (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1839 | Iris prosthesis | Colorado Prior Authorization List, Pg 146 Original policy |
| C1878 | Material for vocal cord medialization, synthetic (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1882 | Cardioverter-defibrillator, other than single or dual chamber (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1883 | Adaptor/extension, pacing lead or neurostimulator lead (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1891 | Infusion pump, nonprogrammable, permanent (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1895 | Lead, cardioverter-defibrillator, endocardial dual coil (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C1896 | Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C2614 | Probe, percutaneous lumbar discectomy | Colorado Prior Authorization List, Pg 146 Original policy |
| C2619 | Pacemaker, dual chamber, nonrate-responsive (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C2620 | Pacemaker, single chamber, nonrate-responsive (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C2621 | Pacemaker, other than single or dual chamber (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |
| C2622 | Prosthesis, penile, noninflatable | Colorado Prior Authorization List, Pg 146 Original policy |
| C2624 | Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components | Colorado Prior Authorization List, Pg 146 Original policy |
| C2626 | Infusion pump, nonprogrammable, temporary (implantable) | Colorado Prior Authorization List, Pg 146 Original policy |