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Anthem Blue Cross Blue Shield of Colorado prior authorization, page 72

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

Prior authorization codes
CodeDescriptionSource
J3245Injection, tildrakizumab, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3247Injection, secukinumab, IV, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3262Injection, tocilizumab, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3263Injection, toripalimab-tpzi, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3285Injection, treprostinil, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3299Injection, triamcinolone acetonide (xipere), 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3304Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3316Injection, triptorelin, extended-release, 3.75 mgColorado Prior Authorization List, Pg 158 Original policy
J3357Ustekinumab, for subcutaneous injection, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3358Ustekinumab, for intravenous injection, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3380Injection, vedolizumab, IV, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3385Injection, velaglucerase alfa, 100 unitsColorado Prior Authorization List, Pg 158 Original policy
J3391Injection, atidarsagene autotemcel, per treatmentColorado Prior Authorization List, Pg 158 Original policy
J3392Injection, exagamglogene autotemcel, per treatmentColorado Prior Authorization List, Pg 158 Original policy
J3393Injection, betibeglogene autotemcel, per treatmentColorado Prior Authorization List, Pg 158 Original policy
J3394Injection, lovotibeglogene autotemcel, per treatmentColorado Prior Authorization List, Pg 158 Original policy
J3397Injection, vestronidase alfa-vjbk, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J3398Injection, voretigene neparvovec-rzyl, 1 billion vector genomesColorado Prior Authorization List, Pg 158 Original policy
J3399Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomesColorado Prior Authorization List, Pg 158 Original policy
J3401Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 mlColorado Prior Authorization List, Pg 158 Original policy
J3402Injection, remestemcel-l-rknd, per therapeutic doseColorado Prior Authorization List, Pg 158 Original policy
J3403Revakinagene taroretcel-lwey, per implantColorado Prior Authorization List, Pg 158 Original policy
J3489Injection, zoledronic acid, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J7170Injection, emicizumab-kxwh, 0.5 mgColorado Prior Authorization List, Pg 158 Original policy
J7171Injection, ADAMTS13, recombinant-krhn, 10 IUColorado Prior Authorization List, Pg 158 Original policy
J7172Injection, marstacimab-hncq, 0.5 mgColorado Prior Authorization List, Pg 158 Original policy
J7173Injection, concizumab-mtci, 0.5 mgColorado Prior Authorization List, Pg 158 Original policy
J7174Injection, fitusiran, 0.04 mgColorado Prior Authorization List, Pg 158 Original policy
J7175Injection, factor x, (human), 1 i.u.Colorado Prior Authorization List, Pg 158 Original policy
J7177Injection, human fibrinogen concentrate (Fibryga), 1 mgColorado Prior Authorization List, Pg 158 Original policy
J7178Injection, human fibrinogen concentrate, not otherwise specified, 1 mgColorado Prior Authorization List, Pg 158 Original policy
J7179Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rcoColorado Prior Authorization List, Pg 158 Original policy
J7180Injection, factor XIII (antihemophilic factor, human), 1 IUColorado Prior Authorization List, Pg 159 Original policy
J7181Injection, factor xiii a-subunit, (recombinant), per iuColorado Prior Authorization List, Pg 159 Original policy
J7182Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iuColorado Prior Authorization List, Pg 159 Original policy
J7183Injection, von Willebrand factor complex (human), Wilate, 1 IU vWF:RCoColorado Prior Authorization List, Pg 159 Original policy
J7185Injection, Factor Viii (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U.Colorado Prior Authorization List, Pg 159 Original policy
J7186Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII i.u.Colorado Prior Authorization List, Pg 159 Original policy
J7187Injection, von Willebrand factor complex (Humate-P), per IU vWF-RC0Colorado Prior Authorization List, Pg 159 Original policy
J7188Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u.Colorado Prior Authorization List, Pg 159 Original policy
J7189Factor VIIa (antihemophilic Factor, recombinant), per 1 mcgColorado Prior Authorization List, Pg 159 Original policy
J7190Factor ViiiColorado Prior Authorization List, Pg 159 Original policy
J7191Factor Viii (Porcine)Colorado Prior Authorization List, Pg 159 Original policy
J7192Factor Viii (Antihemophilic Factor, Recombinant) Per I.U., Not Otherwise SpecifiedColorado Prior Authorization List, Pg 159 Original policy
J7193Factor IX (antihemophilic factor, purified, non-recombinant) per IUColorado Prior Authorization List, Pg 159 Original policy
J7194Factor Ix ComplexColorado Prior Authorization List, Pg 159 Original policy
J7195Factor IX (antihemophilic factor, recombinant) per IUColorado Prior Authorization List, Pg 159 Original policy
J7198Anti-InhibitorColorado Prior Authorization List, Pg 159 Original policy
J7200Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iuColorado Prior Authorization List, Pg 159 Original policy
J7201Injection, factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IUColorado Prior Authorization List, Pg 159 Original policy

Sources

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The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

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