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Anthem Blue Cross Blue Shield of Georgia prior authorization, page 52

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
J2793Injection, Rilonacept, 1 MgStandard Local Prior Authorization Code List, Pg 122 Original policy
J2840Injection, sebelipase alfa, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J2941Injection, somatropin, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J2998Injection, plasminogen, human-tvmh, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3032Injection, eptinezumab-jjmr, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3060Injection, taliglucerace alfa, 10 unitsStandard Local Prior Authorization Code List, Pg 122 Original policy
J3111Injection, romosozumab-aqqg, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3241Injection, teprotumumab-trbw, 10 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3245Injection, tildrakizumab, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3247Injection, secukinumab, IV, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3285Injection, treprostinil, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3299Injection, triamcinolone acetonide (xipere), 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3304Injection, triamcinolone acetonide, preservative- free, extended-release, microsphere formulation, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3316Injection, triptorelin, extended-release, 3.75 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3357Ustekinumab, for subcutaneous injection, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3358Ustekinumab, for intravenous injection, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3380Injection, vedolizumab, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3385Injection, velaglucerase alfa, 100 unitsStandard Local Prior Authorization Code List, Pg 122 Original policy
J3397Injection, vestronidase alfa-vjbk, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J3401Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 109 PFU/ml vector genomes, per 0.1 mlStandard Local Prior Authorization Code List, Pg 122 Original policy
J3489Injection, zoledronic acid, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7170Injection, emicizumab-kxwh, 0.5 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7171Injection, ADAMTS13, recombinant-krhn, 10 IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7172Injection, marstacimab-hncq, 0.5 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7173Injection, concizumab-mtci, 0.5 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7174Injection, fitusiran, 0.04 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7175Injection, Factor X, (human), 1 IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7176Injection, human fibrinogen - chmt (fesilty), 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7177Injection, human fibrinogen concentrate (Fibryga), 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7178Injection, human fibrinogen concentrate, not otherwise specified, 1 mgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7179Injection, von Willebrand factor (recombinant), (Vonvendi), 1 IU VWF:RcoStandard Local Prior Authorization Code List, Pg 122 Original policy
J7180Injection, Factor XIII (antihemophilic factor, human), 1 IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7181Injection, Factor XIII A-subunit, (recombinant), per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7182Injection, Factor VIII, (antihemophilic factor, recombinant), (NovoEight), per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7183Injection, von Willebrand factor complex (human), Wilate, 1 IU VWF:RCOStandard Local Prior Authorization Code List, Pg 122 Original policy
J7185Injection, Factor VIII (antihemophilic factor, recombinant) (Xyntha), per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7186Injection, antihemophilic Factor VIII/von Willebrand factor complex (human), per Factor VIII IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7187Injection, von Willebrand factor complex (Humate- P), per IU VWF:RCOStandard Local Prior Authorization Code List, Pg 122 Original policy
J7188Injection, Factor VIII (antihemophilic factor, recombinant) (Obizur), per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7189Factor VIIa (antihemophilic factor, recombinant), (NovoSeven RT), 1 mcgStandard Local Prior Authorization Code List, Pg 122 Original policy
J7190Factor VIII (antihemophilic factor, human) per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7191Factor VIII (antihemophilic factor (porcine)), per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7192Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specifiedStandard Local Prior Authorization Code List, Pg 122 Original policy
J7193Factor IX (antihemophilic factor, purified, nonrecombinant) per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7194Factor IX complex, per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7195Injection, Factor IX (antihemophilic factor, recombinant) per IU, not otherwise specifiedStandard Local Prior Authorization Code List, Pg 122 Original policy
J7198Antiinhibitor, per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7200Injection, Factor IX, (antihemophilic factor, recombinant), Rixubis, per IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7201Injection, Factor IX, Fc fusion protein, (recombinant), Alprolix, 1 IUStandard Local Prior Authorization Code List, Pg 122 Original policy
J7202Injection, Factor IX, albumin fusion protein, (recombinant), Idelvion, 1 IUStandard Local Prior Authorization Code List, Pg 122 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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