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Blue Cross and Blue Shield of Montana prior authorization, page 12

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
77762Intracavitary Radiation Source Application; Intermediate2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77763Intracavitary Radiation Source Application; Complex2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77767Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Up To 2.0 Cm Or 1 Channel2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77768Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Over 2.0 Cm And 2 Or More Channels Or Multiple Lesions2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77770Remote Afterloading High Dose Rate Radionuclide Interstitial Or Intracavitary Brachytherapy Includes Basic Dosimetry When Performed; 1 Channel2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77771Remote Afterloading High Dose Rate Radionuclide Interstitial Or Intracavitary Brachytherapy Includes Basic Dosimetry When Performed; 2-12 Channels2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77772Remote Afterloading High Dose Rate Radionuclide Interstitial Or Intracavitary Brachytherapy Includes Basic Dosimetry When Performed; Over 12 Channels2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy
77778Interstitial Radiation Source Application Complex Includes Supervision Handling Loading Of Radiation Source When Performed2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
77790Supervision Handling Loading Of Radiation Source2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78012Thyroid Uptake Single Or Multiple Quantitative Measurement(S) (Including Stimulation Suppression Or Discharge When Performed)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78013Thyroid Imaging (Including Vascular Flow When Performed)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78014Thyroid Imaging (Including Vascular Flow When Performed); With Single Or Multiple Uptake(S) Quantitative Measurement(S) (Including Stimulation Suppression Or Discharge When Performed)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78015Thyroid Carcinoma Metastases Imaging; Limited Area (Eg Neck And Chest Only)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78016Thyroid Carcinoma Metastases Imaging; With Additional Studies (Eg Urinary Recovery)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78018Thyroid Carcinoma Metastases Imaging; Whole Body2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78020Thyroid Carcinoma Metastases Uptake (List Separately In Addition To Code For Primary Procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 91 Original policy
78070Parathyroid Planar Imaging (Including Subtraction When Performed)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78071Parathyroid Planar Imaging (Including Subtraction When Performed); With Tomographic (Spect)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78072Parathyroid Planar Imaging (Including Subtraction When Performed); With Tomographic (Spect) And Concurrently Acquired Computed Tomography (Ct) For Anatomical Localization2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78075Adrenal Imaging Cortex And/Or Medulla2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78102Bone Marrow Imaging; Limited Area2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78103Bone Marrow Imaging; Multiple Areas2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78104Bone Marrow Imaging; Whole Body2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78185Spleen Imaging Only With Or Without Vascular Flow2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78195Lymphatics And Lymph Nodes Imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78201Liver Imaging; Static Only2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78202Liver Imaging; With Vascular Flow2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78215Liver And Spleen Imaging; Static Only2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78216Liver And Spleen Imaging; With Vascular Flow2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78226Hepatobiliary System Imaging Including Gallbladder When Present2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78227Hepatobiliary System Imaging Including Gallbladder When Present; With Pharmacologic Intervention Including Quantitative Measurement(S) When Performed2026 Commercial Medical Surgical Prior Authorization Code List, Pg 92 Original policy
78230Salivary Gland Imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78231Salivary Gland Imaging; With Serial Images2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78232Salivary Gland Function Study2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78258Esophageal Motility2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78261Gastric Mucosa Imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78262Gastroesophageal Reflux Study2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78264Gastric Emptying Imaging Study (Eg Solid Liquid Or Both)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78265Gastric Emptying Imaging Study (Eg Solid Liquid Or Both); With Small Bowel Transit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78266Gastric Emptying Imaging Study (Eg Solid Liquid Or Both); With Small Bowel And Colon Transit Multiple Days2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78278Acute Gastrointestinal Blood Loss Imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78290Intestine Imaging (Eg Ectopic Gastric Mucosa Meckel'S Localization Volvulus)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78291Peritoneal-Venous Shunt Patency Test (Eg For Leveen Denver Shunt)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78300Bone And/Or Joint Imaging; Limited Area2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78305Bone And/Or Joint Imaging; Multiple Areas2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78306Bone And/Or Joint Imaging; Whole Body2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78315Bone And/Or Joint Imaging; 3 Phase Study2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78445Non-Cardiac Vascular Flow Imaging (Ie Angiography Venography)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 93 Original policy
78456Acute Venous Thrombosis Imaging Peptide2026 Commercial Medical Surgical Prior Authorization Code List, Pg 94 Original policy
78457Venous Thrombosis Imaging Venogram; Unilateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 94 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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