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Anthem Blue Cross Blue Shield of Colorado prior authorization, page 77

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
K0886POWER WHEELCHAIR, GROUP 4 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 PColorado Prior Authorization List, Pg 164 Original policy
K0890POWER WHEELCHAIR, GROUP 5 PEDIATRIC, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUColorado Prior Authorization List, Pg 164 Original policy
K0891POWER WHEELCHAIR, GROUP 5 PEDIATRIC, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCColorado Prior Authorization List, Pg 164 Original policy
K0899Power mobility device, not coded by DME PDAC or does not meet criteriaColorado Prior Authorization List, Pg 164 Original policy
K1007Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includesColorado Prior Authorization List, Pg 164 Original policy
K1018External upper limb tremor stimulator of the peripheral nerves of the wristColorado Prior Authorization List, Pg 164 Original policy
K1024Nonpneumatic compression controller with sequential calibrated gradient pressureColorado Prior Authorization List, Pg 164 Original policy
K1025Nonpneumatic sequential compression garment, full armColorado Prior Authorization List, Pg 164 Original policy
K1027Oral device/appliance used to reduce upper airway collapsibility, without fixed mechanical hinge, custom fabricated, includes fitting and adjustmentColorado Prior Authorization List, Pg 164 Original policy
K1030External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement onlyColorado Prior Authorization List, Pg 164 Original policy
K1031Nonpneumatic compression controller without calibrated gradient pressureColorado Prior Authorization List, Pg 164 Original policy
K1032Nonpneumatic sequential compression garment, full legColorado Prior Authorization List, Pg 164 Original policy
K1033Nonpneumatic sequential compression garment, half legColorado Prior Authorization List, Pg 164 Original policy
L2006Knee-ankle-foot (KAF) device, any material, single or double upright, swing and stance phase microprocessor control with adjustability, includes all components (e.g., sensorsColorado Prior Authorization List, Pg 164 Original policy
L5987Shank Ft W Vert Load PylonColorado Prior Authorization List, Pg 164 Original policy
L8045Auricular ProsthesisColorado Prior Authorization List, Pg 164 Original policy
L8600Implant Breast Silicone/EqColorado Prior Authorization List, Pg 164 Original policy
L8607Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary suppliesColorado Prior Authorization List, Pg 164 Original policy
L8614COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTSColorado Prior Authorization List, Pg 164 Original policy
L8619Cochlear Implant, External Speech Processor And Controller, Integrated System, ReplacementColorado Prior Authorization List, Pg 164 Original policy
L8627Cochlear Implant, External Speech Processor, Component, ReplacementColorado Prior Authorization List, Pg 164 Original policy
L8628Cochlear Implant, External Controller Component, ReplacementColorado Prior Authorization List, Pg 165 Original policy
L8678Electrical stimulator supplies (external) for use with implantable neurostimulator, per monthColorado Prior Authorization List, Pg 165 Original policy
L8679Implantable neurostimulator, pulse generator, any typeColorado Prior Authorization List, Pg 165 Original policy
L8680Implantable neurostimulator electrode, eachColorado Prior Authorization List, Pg 165 Original policy
L8681Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement onlyColorado Prior Authorization List, Pg 165 Original policy
L8682Implantable neurostimulator radiofrequency receiverColorado Prior Authorization List, Pg 165 Original policy
L8683Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiverColorado Prior Authorization List, Pg 165 Original policy
L8684Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladdeColorado Prior Authorization List, Pg 165 Original policy
L8685Implantable neurostimulator pulse generator, single array, rechargeable, includes extensionColorado Prior Authorization List, Pg 165 Original policy
L8686Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extensionColorado Prior Authorization List, Pg 165 Original policy
L8687Implantable neurostimulator pulse generator, dual array, rechargeable, includes extensionColorado Prior Authorization List, Pg 165 Original policy
L8688Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extensionColorado Prior Authorization List, Pg 165 Original policy
L8690AUDITORY OSSEOINTEGRATED DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTSColorado Prior Authorization List, Pg 165 Original policy
L8691Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, eachColorado Prior Authorization List, Pg 165 Original policy
L8692Auditory Osseointegrated Device, External Sound Processor, Used Without Osseointegration, Body Worn, Includes Headband OColorado Prior Authorization List, Pg 165 Original policy
L8693Auditory osseointegrated device abutment, any length, replacement onlyColorado Prior Authorization List, Pg 165 Original policy
L8694Auditory osseointegrated device, transducer/actuator, replacement only, eachColorado Prior Authorization List, Pg 165 Original policy
L8701Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, cColorado Prior Authorization List, Pg 165 Original policy
L8702Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessorieColorado Prior Authorization List, Pg 166 Original policy
Q2026Injection, Radiesse, 0.1mlColorado Prior Authorization List, Pg 166 Original policy
Q2028Injection, sculptra, 0.5 mgColorado Prior Authorization List, Pg 166 Original policy
Q2041Axicabtagene ciloleucel, up to 200 million autologous anti-CD19 CAR positive T cells, including leukapheresis and dose preparation procedures, per therapeutic doseColorado Prior Authorization List, Pg 166 Original policy
Q2042Tisagenlecleucel, up to 600 million CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic doseColorado Prior Authorization List, Pg 166 Original policy
Q2043Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm- csf, including leukapheresis and all other preparatory procedures, per infusionColorado Prior Authorization List, Pg 166 Original policy
Q2053Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic doseColorado Prior Authorization List, Pg 166 Original policy
Q2054Lisocabtagene maraleucel, up to 110 million autologous anti-CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic doseColorado Prior Authorization List, Pg 166 Original policy
Q2055Idecabtagene vicleucel, up to 510 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, pColorado Prior Authorization List, Pg 166 Original policy
Q2056Ciltacabtagene autoleucel, up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation proceduresColorado Prior Authorization List, Pg 166 Original policy
Q2057Afamitresgene autoleucel, including leukapheresis and dose preparation procedures, per therapeutic doseColorado Prior Authorization List, Pg 166 Original policy

Sources

Disclaimer

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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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