Anthem Blue Cross Blue Shield of Colorado prior authorization, page 65
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 |
|---|---|---|
| D7858 | joint reconstruction | Colorado Prior Authorization List, Pg 150 Original policy |
| D7860 | arthrotomy | Colorado Prior Authorization List, Pg 150 Original policy |
| D7865 | arthroplasty | Colorado Prior Authorization List, Pg 150 Original policy |
| D7870 | arthrocentesis | Colorado Prior Authorization List, Pg 150 Original policy |
| D7871 | non-arthroscopic lysis and lavage | Colorado Prior Authorization List, Pg 150 Original policy |
| D7873 | arthroscopy: lavage and lysis of adhesions | Colorado Prior Authorization List, Pg 150 Original policy |
| D7874 | arthroscopy: disc repositioning and stabilization | Colorado Prior Authorization List, Pg 150 Original policy |
| D7875 | arthroscopy: synovectomy | Colorado Prior Authorization List, Pg 150 Original policy |
| D7876 | arthroscopy: discectomy | Colorado Prior Authorization List, Pg 150 Original policy |
| D7877 | arthroscopy: debridement | Colorado Prior Authorization List, Pg 150 Original policy |
| D7940 | osteoplasty - for orthognathic deformities | Colorado Prior Authorization List, Pg 150 Original policy |
| D7941 | osteotomy - mandibular rami | Colorado Prior Authorization List, Pg 150 Original policy |
| D7943 | osteotomy - mandibular rami with bone graft; includes obtaining the graft | Colorado Prior Authorization List, Pg 150 Original policy |
| D7944 | osteotomy - segmented or subapical | Colorado Prior Authorization List, Pg 150 Original policy |
| D7945 | osteotomy - body of mandible | Colorado Prior Authorization List, Pg 150 Original policy |
| D7946 | LeFort I (maxilla - total) | Colorado Prior Authorization List, Pg 150 Original policy |
| D7947 | LeFort I (maxilla - segmented) | Colorado Prior Authorization List, Pg 150 Original policy |
| D7948 | LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graft | Colorado Prior Authorization List, Pg 150 Original policy |
| D7949 | LeFort II or LeFort III - with bone graft | Colorado Prior Authorization List, Pg 150 Original policy |
| D7950 | osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report | Colorado Prior Authorization List, Pg 150 Original policy |
| D7995 | synthetic graft - mandible or facial bones, by report | Colorado Prior Authorization List, Pg 150 Original policy |
| D7996 | implant-mandible for augmentation purposes (excluding alveolar ridge), by report | Colorado Prior Authorization List, Pg 150 Original policy |
| D9222 | deep sedation/general anesthesia - first 15 minutes | Colorado Prior Authorization List, Pg 150 Original policy |
| D9223 | deep sedation/general anesthesia - each subsequent 15 minute increment | Colorado Prior Authorization List, Pg 150 Original policy |
| D9950 | occlusion analysis - mounted case | Colorado Prior Authorization List, Pg 150 Original policy |
| D9951 | occlusal adjustment - limited | Colorado Prior Authorization List, Pg 150 Original policy |
| D9952 | occlusal adjustment - complete | Colorado Prior Authorization List, Pg 150 Original policy |
| E0217 | Water Circ Heat Pad W Pump | Colorado Prior Authorization List, Pg 150 Original policy |
| E0470 | Respiratory assist device, bi-level pressure capability, without backup rate | Colorado Prior Authorization List, Pg 150 Original policy |
| E0471 | Respiratory assist device, bi-level pressure capability, with back-up rate | Colorado Prior Authorization List, Pg 150 Original policy |
| E0481 | Intrapulmonary percussive ventilation system and related accessories | Colorado Prior Authorization List, Pg 150 Original policy |
| E0485 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes | Colorado Prior Authorization List, Pg 150 Original policy |
| E0486 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, inclu | Colorado Prior Authorization List, Pg 150 Original policy |
| E0490 | Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remote | Colorado Prior Authorization List, Pg 150 Original policy |
| E0491 | Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hard | Colorado Prior Authorization List, Pg 150 Original policy |
| E0492 | Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone application | Colorado Prior Authorization List, Pg 150 Original policy |
| E0493 | Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phon | Colorado Prior Authorization List, Pg 150 Original policy |
| E0530 | Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type | Colorado Prior Authorization List, Pg 151 Original policy |
| E0561 | Humidifier, non-heated, used with positive airway pressure device | Colorado Prior Authorization List, Pg 151 Original policy |
| E0562 | Humidifier, heated, used with positive airway pressure device | Colorado Prior Authorization List, Pg 151 Original policy |
| E0601 | Continuous positive airway pressure (cpap) device | Colorado Prior Authorization List, Pg 151 Original policy |
| E0616 | Cardiac Event Recorder | Colorado Prior Authorization List, Pg 151 Original policy |
| E0650 | Pneuma Compresor Non-Segment | Colorado Prior Authorization List, Pg 151 Original policy |
| E0651 | Pneum Compressor Segmental | Colorado Prior Authorization List, Pg 151 Original policy |
| E0652 | Pneum Compres W/Cal Pressure | Colorado Prior Authorization List, Pg 151 Original policy |
| E0655 | Pneumatic Appliance Half Arm | Colorado Prior Authorization List, Pg 151 Original policy |
| E0656 | Segmental pneumatic appliance for use with pneumatic compressor, trunk | Colorado Prior Authorization List, Pg 151 Original policy |
| E0657 | Segmental pneumatic appliance for use with pneumatic compressor, chest | Colorado Prior Authorization List, Pg 151 Original policy |
| E0658 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest | Colorado Prior Authorization List, Pg 151 Original policy |
| E0660 | Pneumatic Appliance Full Leg | Colorado Prior Authorization List, Pg 151 Original policy |