Anthem Blue Cross Blue Shield of Georgia prior authorization, page 22
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 |
|---|---|---|
| 92609 | Therapeutic services for the use of speech- generating device, including programming and modification | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92610 | Evaluation of oral and pharyngeal swallowing function | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92611 | Motion fluoroscopic evaluation of swallowing function by cine or video recording | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92618 | Evaluation for prescription of non-speech- generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92626 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92627 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92630 | Auditory rehabilitation; prelingual hearing loss | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92633 | Auditory rehabilitation; postlingual hearing loss | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92924 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92930 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 2 or more distinct coronary lesions with 2 or more coronary stents deployed in 2 or more coronary segments, or a bifurcation lesion requiring angioplasty and/or stenting in both the main artery and the side branch | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92933 | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92937 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92943 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 92945 | Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; combined antegrade and retrograde approaches | Standard Local Prior Authorization Code List, Pg 55 Original policy |
| 93145 | Interrogation device evaluation (in person), carotid sinus baroreflex activation therapy (BAT) modulation system including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day); without programming | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93150 | Therapy activation of implanted phrenic nerve stimulator system, including all interrogation and programming | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93151 | Interrogation and programming (minimum one parameter) of implanted phrenic nerve stimulator system | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93152 | Interrogation and programming of implanted phrenic nerve stimulator system during polysomnography | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93153 | Interrogation without programming of implanted phrenic nerve stimulator system | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93303 | Transthoracic echocardiography for congenital cardiac anomalies; complete | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93304 | Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93306 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93307 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93308 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93312 | Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93313 | Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93314 | Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93315 | Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93316 | Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93317 | Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93350 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93351 | Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93454 | Catheter placement in, Coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation | Standard Local Prior Authorization Code List, Pg 56 Original policy |
| 93455 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93456 | Catheter placement in, Coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93457 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93458 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93459 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93460 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93461 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93600 | Bundle of His recording | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93602 | Intra-atrial recording | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93603 | Right ventricular recording | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93619 | Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93620 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93624 | Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93650 | Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement | Standard Local Prior Authorization Code List, Pg 57 Original policy |
| 93653 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3- dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re- entry | Standard Local Prior Authorization Code List, Pg 58 Original policy |