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Blue Cross and Blue Shield of Montana prior authorization, page 31

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
S3840Dna Analysis For Germline Mutations Of The Ret Proto-Oncogene For Susceptibility To Multiple Endocrine Neoplasia Type 22026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3841Genetic Testing For Retinoblastoma2026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3842Genetic Testing For Von Hippel-Lindau Disease2026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3844Dna Analysis Of The Connexin 26 Gene (Gjb2) For Susceptibility To Congenital Profound Deafness2026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3845Genetic Testing For Alpha-Thalassemia2026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3846Genetic Testing For Hemoglobin E Beta- Thalassemia2026 Commercial Medical Surgical Prior Authorization Code List, Pg 281 Original policy
S3849Genetic Testing For Niemann-Pick Disease2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3850Genetic Testing For Sickle Cell Anemia2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3852Dna Analysis For Apoe Epsilon 4 Allele For Susceptibility To Alzheimer'S Disease2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3853Genetic Testing For Myotonic Muscular Dystrophy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3854Gene Expression Profiling Panel For Use In The Management Of Breast Cancer Treatment2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3861Genetic Testing Sodium Channel Voltage- Gated Type V Alpha Subunit (Scn5A) And Variants For Suspected Brugada Syndrome2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3865Comprehensive Gene Sequence Analysis For Hypertrophic Cardiomyopathy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3866Genetic Analysis For A Specific Gene Mutation For Hypertrophic Cardiomyopathy (Hcm) In An Individual With A Known Hcm Mutation In The Family2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S3870Comparative Genomic Hybridization (Cgh) Microarray Testing For Developmental Delay Autism Spectrum Disorder And/Or Intellectual Disability2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S5035Home Infusion Therapy Routine Service Of Infusion Device (E. G. Pump Maintenance)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 282 Original policy
S5036Home Infusion Therapy Repair Of Infusion Device (E. G. Pump Repair)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 283 Original policy
S5497Home Infusion Therapy Catheter Care / Maintenance Not Otherwise Classified; Includes Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 283 Original policy
S5498Hit Simple Cath Care2026 Commercial Medical Surgical Prior Authorization Code List, Pg 283 Original policy
S5501Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5502Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5517Hit Declotting Kit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5518Hit Cath Repair Kit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5520Hit Picc Insert Kit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5521Hit Midline Cath Insert Kit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5522Hit Picc Insert No Supp2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S5523Hip Midline Cath Insert Kit2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S8030Scleral Application Of Tantalum Ring(S) For Localization Of Lesions For Proton Beam Therapy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S8037Magnetic Resonance Cholangiopancreatography (Mrcp)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S9061Medical Supplies And Equipme2026 Commercial Medical Surgical Prior Authorization Code List, Pg 284 Original policy
S9211Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 286 Original policy
S9212Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 287 Original policy
S9213Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 287 Original policy
S9214Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 287 Original policy
S9325Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with s9326, s9327 or s9328)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 288 Original policy
S9326Home infusion therapy, continuous (twenty-BCBSMT four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 288 Original policy
S9327Home infusion therapy, intermittent (less than twenty-four hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 288 Original policy
S9328Hit Pain Imp Pump Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 288 Original policy
S9329Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with s9330 or s9331)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 289 Original policy
S9330Home infusion therapy, continuous (twenty-BCBSMT four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 289 Original policy
S9331Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 289 Original policy
S9336Home infusion therapy, continuous anticoagulant infusion therapy (e. G. Heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 290 Original policy
S9338Hit Immunotherapy Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 290 Original policy
S9339Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 290 Original policy
S9340Home Therapy; Enteral Nutrition; Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Enteral Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 290 Original policy
S9341Home Therapy; Enteral Nutrition Via Gravity; Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Enteral Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 291 Original policy
S9342Home Therapy; Enteral Nutrition Via Pump; Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Enteral Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 291 Original policy
S9343Home Therapy; Enteral Nutrition Via Bolus; Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Enteral Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 291 Original policy
S9345Home infusion therapy, anti-hemophilic agent infusion therapy (e. G. Factor viii); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 291 Original policy
S9346Hit Alpha-1-Proteinas Diem2026 Commercial Medical Surgical Prior Authorization Code List, Pg 291 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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