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Blue Cross and Blue Shield of Montana prior authorization

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
11950Subcutaneous injection of filling material (eg, collagen); 1 cc or less2026 Commercial Medical Surgical Prior Authorization Code List, Pg 1 Original policy
11951Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc2026 Commercial Medical Surgical Prior Authorization Code List, Pg 1 Original policy
11952Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
11954Subcutaneous injection of filling material (eg, collagen); over 10.0 cc2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
11980Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
11981Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non- biodegradable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15271Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15275Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15780Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15781Dermabrasion; segmental, face2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15782Dermabrasion; regional, other than face2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15783Dermabrasion; superficial, any site (eg, tattoo removal)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15788Chemical peel, facial; epidermal2026 Commercial Medical Surgical Prior Authorization Code List, Pg 2 Original policy
15789Chemical peel, facial; dermal2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15820Blepharoplasty, lower eyelid2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15821Blepharoplasty, lower eyelid; with extensive herniated fat pad2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15822Blepharoplasty, upper eyelid2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15823Blepharoplasty, upper eyelid; with excessive skin weighting down lid2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15824Rhytidectomy; Forehead2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15825Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15826Rhytidectomy; Glabellar Frown Lines2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15828Rhytidectomy; cheek, chin, and neck2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15830Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15832Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15833Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15834Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15835Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock2026 Commercial Medical Surgical Prior Authorization Code List, Pg 3 Original policy
15836Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15837Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15838Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15839Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15847Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15876Suction assisted lipectomy; head and neck2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15877Suction assisted lipectomy; trunk2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15878Suction assisted lipectomy; upper extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
15879Suction assisted lipectomy; lower extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 4 Original policy
19294Preparation Of Tumor Cavity With Placement Of A Radiation Therapy Applicator For Intraoperative Radiation Therapy (Iort) Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 5 Original policy
19296Placement Of Radiotherapy Afterloading Expandable Catheter (Single Or Multichannel) Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy Includes Imaging Guidance; On Date Separate From Partial Mastectomy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 5 Original policy
19297Placement Of Radiotherapy Afterloading Expandable Catheter (Single Or Multichannel) Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy Includes Imaging Guidance; Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 5 Original policy
19298Placement Of Radiotherapy After Loading Brachytherapy Catheters (Multiple Tube And Button Type) Into The Breast For Interstitial Radioelement Application Following (At The Time Of Or Subsequent To) Partial Mastectomy Includes Imaging Guidance2026 Commercial Medical Surgical Prior Authorization Code List, Pg 5 Original policy
19300Mastectomy for gynecomastia2026 Commercial Medical Surgical Prior Authorization Code List, Pg 5 Original policy
19303Mastectomy, simple, complete2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
19316Mastopexy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
19318Breast reduction2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
19325Breast augmentation with implant2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
19371Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
20555Placement Of Needles Or Catheters Into Muscle And/Or Soft Tissue For Subsequent Interstitial Radioelement Application (At The Time Of Or Subsequent To The Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
20930Allograft Morselized Or Placement Of Osteopromotive Material For Spine Surgery Only (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
20931Allograft Structural For Spine Surgery Only (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 6 Original policy
20932Allograft Includes Templating Cutting Placement And Internal Fixation When Performed; Osteoarticular Including Articular Surface And Contiguous Bone (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 7 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.

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