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Blue Cross and Blue Shield of Montana prior authorization, page 35

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
J2182Injection Mepolizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2267mirikizumab-mrkz BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2323Injection Natalizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2326Injection Nusinersen 0.1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2327Injection, Risankizumab- BCBSMT Rzaa, Intravenous, 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2329Injection, ublituximab-xiiy, BCBSMT 1mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2350Injection Ocrelizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2351Injection, ocrelizumab, 1 mg BCBSMT and hyaluronidase-ocsq2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2353Injection Octreotide Depot Carelon or Form For Intramuscular BCBSMT Injection 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2354Injection Octreotide Non- BCBSMT Depot Form For Subcutaneous Or Intravenous Injection 25 Mcg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2356Injection Tezepelumab-Ekko BCBSMT 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2357Injection Omalizumab 5 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 11 Original policy
J2361Exdensur (depemokimab- BCBSMT ulaa)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2506Injection Pegfilgrastim Carelon Excludes Biosimilar 0.5 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2507Injection Pegloticase 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2508Injection, pegunigalsidase BCBSMT alfa-iwxj, 1 mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2786Injection Reslizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2802Injection, romiplostim, 1 BCBSMT microgram2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2820Injection Sargramostim (Gm- Carelon Csf) 50 Mcg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2840Injection Sebelipase Alfa 1 BCBSMT Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2860Injection Siltuximab 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J2941Injection Somatropin 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3032Injection Eptinezumab-Jjmr 1 BCBSMT Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3055Injection Talquetamab-Tgvs Carelon 0.25 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3060Injection Taliglucerace Alfa BCBSMT 10 Units2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3111Injection Romosozumab- BCBSMT Aqqg 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3241Injection Teprotumumab- BCBSMT Trbw 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3245Injection Tildrakizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3247Injection, secukinumab, BCBSMT intravenous, 1 mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 12 Original policy
J3262Injection Tocilizumab 1 Mg BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3263Loqtorzi (toripalimab-tpzi)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3358Ustekinumab For Intravenous BCBSMT Injection 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3380Injection Vedolizumab BCBSMT Intravenous 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3385Injection Velaglucerase Alfa BCBSMT 100 Units2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3386Waskyra (etuvetidigene BCBSMT autotemcel)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3387Skysona (elivaldogene BCBSMT autotemcel)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3389Zevaskyn (prademagene BCBSMT zamikeracel)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3391Injection, atidarsagene BCBSMT autotemcel, per treatment2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3392Injection, exagamglogene BCBSMT autotemcel, per treatment2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3393Injection, betibeglogene BCBSMT autotemcel, per treatment2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3394Injection, lovotibeglogene BCBSMT autotemcel, per treatment2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3397Injection Vestronidase Alfa- BCBSMT Vjbk 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3398Injection Voretigene BCBSMT Neparvovec-Rzyl 1 Billion Vector Genomes2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3399Injection Onasemnogene BCBSMT Abeparvovec-Xioi Per Treatment Up To 5X10^15 Vector Genomes2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 13 Original policy
J3401Beremagene Geperpavec- BCBSMT Svdt For Topical Administration Containing Nominal 5 X 10^9 Pfu/Ml Vector Genomes Per 0.1 Ml2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 14 Original policy
J3402Injection, remestemcel-l- BCBSMT rknd, per therapeutic dose2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 14 Original policy
J3403Revakinagene taroretcel- BCBSMT lwey, per implant2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 14 Original policy
J3404Papzimeos (zopapogene BCBSMT imadenovec-drba)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 14 Original policy
J3405Itvisma (onasemnogene BCBSMT abeparvovec-brve)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 14 Original policy
J3490Unclassified Drugs2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 15 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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