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Blue Cross and Blue Shield of Montana prior authorization, page 27

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
C1605Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1734Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1737Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1764Event recorder, cardiac (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1767Generator, neurostimulator (implantable), non-rechargeable2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1778Lead, neurostimulator (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1817Septal defect implant system, intracardiac2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1820Generator, neurostimulator (implantable), with rechargeable battery and charging system2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1821Interspinous process distraction device (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 253 Original policy
C1822Generator Neurostimulator (Implantable) High Frequency With Rechargeable Battery And Charging System2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C1826Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C1833Monitor, cardiac, including intracardiac lead and all system components (implantable)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C2616Brachytherapy source, non-stranded, yttrium-90, per source2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C2624Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C7504Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C7505Percutaneous vertebroplasties (bone biopsies included when performed), first lumbosacral and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance2026 Commercial Medical Surgical Prior Authorization Code List, Pg 254 Original policy
C7507Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C7508Percutaneous vertebral augmentations, first lumbar and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C8900Magnetic Resonance Angiography With Contrast Abdomen2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C8901Magnetic Resonance Angiography Without Contrast Abdomen2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C8902Magnetic Resonance Angiography Without Contrast Followed By With Contrast Abdomen2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C8903Magnetic Resonance Imaging With Contrast Breast; Unilateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 255 Original policy
C8905Magnetic Resonance Imaging Without Contrast Followed By With Contrast Breast; Unilateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8906Magnetic Resonance Imaging With Contrast Breast; Bilateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8908Magnetic Resonance Imaging Without Contrast Followed By With Contrast Breast; Bilateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8909Magnetic Resonance Angiography With Contrast Chest (Excluding Myocardium)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8910Magnetic Resonance Angiography Without Contrast Chest (Excluding Myocardium)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8911Magnetic Resonance Angiography Without Contrast Followed By With Contrast Chest (Excluding Myocardium)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8912Magnetic Resonance Angiography With Contrast Lower Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8913Magnetic Resonance Angiography Without Contrast Lower Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8914Magnetic Resonance Angiography Without Contrast Followed By With Contrast Lower Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8918Magnetic Resonance Angiography With Contrast Pelvis2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8919Magnetic Resonance Angiography Without Contrast Pelvis2026 Commercial Medical Surgical Prior Authorization Code List, Pg 256 Original policy
C8920Magnetic Resonance Angiography Without Contrast Followed By With Contrast Pelvis2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8931Magnetic Resonance Angiography With Contrast Spinal Canal And Contents2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8932Magnetic Resonance Angiography Without Contrast Spinal Canal And Contents2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8933Magnetic Resonance Angiography Without Contrast Followed By With Contrast Spinal Canal And Contents2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8934Magnetic Resonance Angiography With Contrast Upper Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8935Magnetic Resonance Angiography Without Contrast Upper Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C8936Magnetic Resonance Angiography Without Contrast Followed By With Contrast Upper Extremity2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C9359Porous Purified Collagen Matrix Bone Void Filler (Integra Mozaik Osteoconductive Scaffold Putty Integra Os Osteoconductive Scaffold Putty) Per 0.5 Cc2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C9362Porous Purified Collagen Matrix Bone Void Filler (Integra Mozaik Osteoconductive Scaffold Strip) Per 0.5 Cc2026 Commercial Medical Surgical Prior Authorization Code List, Pg 257 Original policy
C9740Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
C9762Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction, with strain imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
C9763Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction, with stress imaging2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
C9785Endoscopic outlet reduction, gastric pouch application, with endoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
E0493Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
E0652Pneumatic compressor, segmental home model with calibrated gradient pressure2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
E0673Segmental gradient pressure pneumatic appliance, half leg2026 Commercial Medical Surgical Prior Authorization Code List, Pg 258 Original policy
E0676Intermittent limb compression device (includes all accessories), not otherwise specified2026 Commercial Medical Surgical Prior Authorization Code List, Pg 259 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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