Anthem Blue Cross Blue Shield of Georgia prior authorization, page 38
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 |
|---|---|---|
| 30120 | Excision or surgical planing of skin of nose for rhinophyma | Standard Local Prior Authorization Code List, Pg 97 Original policy |
| 30400 | Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip | Standard Local Prior Authorization Code List, Pg 97 Original policy |
| 30410 | Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 30420 | Rhinoplasty, primary; including major septal repair | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 30430 | Rhinoplasty, secondary; minor revision (small amount of nasal tip work) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 30435 | Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 30450 | Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 30999 | Unlisted procedure, nose | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32850 | Donor pneumonectomy(s) (including cold preservation), from cadaver donor | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32851 | Lung Transplant, Single; W/O Cardiopulmonary Bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32852 | Lung Transplant, Single; W/Cardiopulmonary Bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32853 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/O Cardiopulmonary Bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32854 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/Cardiopulmonary Bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32855 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Unilateral | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 32856 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Bilateral | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33418 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33927 | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33928 | Removal and replacement of total replacement heart system (artificial heart) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33930 | Donor cardiectomy-pneumonectomy (including cold preservation) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33933 | Backbench Standard Preparation Of Cadaver Donor Heart/Lung Allograft | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33935 | Heart-Lung Transplant W/Recipient Cardiectomy- Pneumonectomy | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33940 | Donor cardiectomy (including cold preservation) | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33944 | Backbench Standard Preparation Of Cadaver Donor Heart Allograft | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33945 | Heart Transplant, W/Wo Recipient Cardiectomy | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33975 | Insertion of ventricular assist device; extracorporeal, single ventricle | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33976 | Insertion of ventricular assist device; extracorporeal, biventricular | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33979 | Insertion of ventricular assist device, implantable intracorporeal, single ventricle | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33981 | Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33982 | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33983 | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33990 | Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only | Standard Local Prior Authorization Code List, Pg 98 Original policy |
| 33991 | Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 33993 | Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 33995 | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 33999 | Unlisted procedure, cardiac surgery | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38204 | Management, Recipient Hematopoietic Progenitor Cell Donor Search & Cell Acquisition | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38205 | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38206 | Blood-Derived Hematopoietic Progenitor Cell Harvesting, Transplantation/Collection; Autologous | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38207 | Transplant Preparation, Hematopoietic Progenitor Cells; Cryopreservation & Storage | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38208 | Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, without washing, per donor | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38209 | Transplant preparation of hematopoietic progenitor cells; thawing of previously frozen harvest, with washing, per donor | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38210 | Transplant Prep, Hematopoietic Progenitor Cells; Specfc Cell Deplet W/In Harvest, T-Cell Deplete | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38211 | Transplant Preparation, Hematopoietic Progenitor Cells; Tumor Cell Deplete | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38212 | Transplant Preparation, Hematopoietic Progenitor Cells; Red Blood Cell Removal | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38213 | Transplant Preparation, Hematopoietic Progenitor Cells; Platelet Depletion | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38214 | Transplant Preparation, Hematopoietic Progenitor Cells; Plasma (Volume) Depletion | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38215 | Transplant Prep, Hematoiepotic Progenitor Cells; Cell Conc, Plasma/Mononuclear/Buffy Coat | Standard Local Prior Authorization Code List, Pg 99 Original policy |
| 38230 | Bone marrow harvesting for transplantation; allogeneic | Standard Local Prior Authorization Code List, Pg 100 Original policy |
| 38232 | Bone Marrow Harvesting For Transplantation; Autologous | Standard Local Prior Authorization Code List, Pg 100 Original policy |