Anthem Blue Cross Blue Shield of Colorado prior authorization, page 86

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
Code	Description	Source
S9502	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours	Colorado Prior Authorization List, Pg 178 Original policy
S9503	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every six hours	Colorado Prior Authorization List, Pg 178 Original policy
S9504	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every four hours	Colorado Prior Authorization List, Pg 178 Original policy
S9960	Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)	Colorado Prior Authorization List, Pg 178 Original policy
S9961	Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)	Colorado Prior Authorization List, Pg 178 Original policy
T1000	Private duty/independent nursing service(s) - licensed, up to 15 minutes	Colorado Prior Authorization List, Pg 178 Original policy
T1002	RN services, up to 15 minutes	Colorado Prior Authorization List, Pg 178 Original policy
T1003	LPN/LVN services, up to 15 minutes	Colorado Prior Authorization List, Pg 178 Original policy
T1030	Nursing Care, In The Home, By Registered Nurse, Per Diem	Colorado Prior Authorization List, Pg 178 Original policy
T1031	Nursing Care, In The Home, By Licensed Practical Nurse, Per Diem	Colorado Prior Authorization List, Pg 178 Original policy
T2036	Therapeutic camping, overnight, waiver; each session	Colorado Prior Authorization List, Pg 178 Original policy
T2037	Therapeutic camping, day, waiver; each session	Colorado Prior Authorization List, Pg 178 Original policy
V2787	Astigmatism correcting function of intraocular lens	Colorado Prior Authorization List, Pg 178 Original policy
V2788	Presbyopia correcting function of intraocular lens	Colorado Prior Authorization List, Pg 178 Original policy
V2790	Amniotic Membrane	Colorado Prior Authorization List, Pg 178 Original policy
V5095	Semi-Implantable Middle Ear Hearing Prosthesis	Colorado Prior Authorization List, Pg 178 Original policy
V5298	Hearing Aid, Not Otherwise Classified	Colorado Prior Authorization List, Pg 178 Original policy
V5362	Speech Screening	Colorado Prior Authorization List, Pg 179 Original policy
V5363	Language Screening	Colorado Prior Authorization List, Pg 179 Original policy
V5364	Dysphagia Screening	Colorado Prior Authorization List, Pg 179 Original policy

Sources

Colorado Prior Authorization List