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Blue Cross and Blue Shield of Montana prior authorization, page 10

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
72142Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Cervical; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72146Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Thoracic; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72147Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Thoracic; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72148Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Lumbar; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72149Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Lumbar; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72156Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Without Contrast Material Followed By Contrast Material(S) And Further Sequences; Cervical2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72157Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Without Contrast Material Followed By Contrast Material(S) And Further Sequences; Thoracic2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72158Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Without Contrast Material Followed By Contrast Material(S) And Further Sequences; Lumbar2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72159Magnetic Resonance Angiography Spinal Canal And Contents With Or Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72191Computed Tomographic Angiography Pelvis With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72192Computed Tomography Pelvis; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72193Computed Tomography Pelvis; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72194Computed Tomography Pelvis; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72195Magnetic Resonance (Eg Proton) Imaging Pelvis; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 78 Original policy
72196Magnetic Resonance (Eg Proton) Imaging Pelvis; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
72197Magnetic Resonance (Eg Proton) Imaging Pelvis; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
72198Magnetic Resonance Angiography Pelvis With Or Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73200Computed Tomography Upper Extremity; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73201Computed Tomography Upper Extremity; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73202Computed Tomography Upper Extremity; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73206Computed Tomographic Angiography Upper Extremity With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73218Magnetic Resonance (Eg Proton) Imaging Upper Extremity Other Than Joint; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73219Magnetic Resonance (Eg Proton) Imaging Upper Extremity Other Than Joint; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 79 Original policy
73220Magnetic Resonance (Eg Proton) Imaging Upper Extremity Other Than Joint; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73221Magnetic Resonance (Eg Proton) Imaging Any Joint Of Upper Extremity; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73222Magnetic Resonance (Eg Proton) Imaging Any Joint Of Upper Extremity; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73223Magnetic Resonance (Eg Proton) Imaging Any Joint Of Upper Extremity; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73225Magnetic Resonance Angiography Upper Extremity With Or Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73700Computed Tomography Lower Extremity; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73701Computed Tomography Lower Extremity; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73702Computed Tomography Lower Extremity; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 80 Original policy
73706Computed Tomographic Angiography Lower Extremity With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73718Magnetic Resonance (Eg Proton) Imaging Lower Extremity Other Than Joint; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73719Magnetic Resonance (Eg Proton) Imaging Lower Extremity Other Than Joint; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73720Magnetic Resonance (Eg Proton) Imaging Lower Extremity Other Than Joint; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73721Magnetic Resonance (Eg Proton) Imaging Any Joint Of Lower Extremity; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73722Magnetic Resonance (Eg Proton) Imaging Any Joint Of Lower Extremity; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73723Magnetic Resonance (Eg Proton) Imaging Any Joint Of Lower Extremity; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 81 Original policy
73725Magnetic Resonance Angiography Lower Extremity With Or Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74150Computed Tomography Abdomen; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74160Computed Tomography Abdomen; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74170Computed Tomography Abdomen; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74174Computed Tomographic Angiography Abdomen And Pelvis With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74175Computed Tomographic Angiography Abdomen With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74176Computed Tomography Abdomen And Pelvis; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74177Computed Tomography Abdomen And Pelvis; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74178Computed Tomography Abdomen And Pelvis; Without Contrast Material In One Or Both Body Regions Followed By Contrast Material(S) And Further Sections In One Or Both Body Regions2026 Commercial Medical Surgical Prior Authorization Code List, Pg 82 Original policy
74181Magnetic Resonance (Eg Proton) Imaging Abdomen; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 83 Original policy
74182Magnetic Resonance (Eg Proton) Imaging Abdomen; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 83 Original policy
74183Magnetic Resonance (Eg Proton) Imaging Abdomen; Without Contrast Material(S) Followed By With Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 83 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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