Talk to Us

Blue Cross and Blue Shield of Montana prior authorization, page 36

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
J3590Unclassified Biologics2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 16 Original policy
J7183Injection Von Willebrand BCBSMT Factor Complex (Human) Wilate 1 I.U. Vwf:Rco2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 16 Original policy
J9011Injection, datopotamab Carelon deruxtecan-dlnk, 1 mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9019Injection Asparaginase Carelon (Erwinaze) 1 000 Iu2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9021Injection Asparaginase Carelon Recombinant (Rylaze) 0.1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9022Injection Atezolizumab 10 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9023Injection Avelumab 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9024Tecentriq Hybreza Carelon (atezolizumab and hyaluronidase-tqjs)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9026Injection, tarlatamab-dlle, 1 Carelon mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9028Injection, nogapendekin alfa Carelon inbakicept-pmln, for intravesical use, 1 microgram2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9029Intravesical Instillation BCBSMT Nadofaragene Firadenovec- Vncg Per Therapeutic Dose2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9032Injection Belinostat 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9035Injection Bevacizumab 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9039Injection Blinatumomab 1 Carelon Microgram2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9042Injection Brentuximab Carelon Vedotin 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9043Injection Cabazitaxel 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9047Injection Carfilzomib 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9053Blenrep (belantamab Carelon mafodotin-blmf)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 17 Original policy
J9055Injection Cetuximab 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9061Injection Amivantamab-Vmjw Carelon 2 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9062Rybrevant Faspro Carelon (amivantamab/hyaluronidase- lpuj)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9063Injection Mirvetuximab Carelon Soravtansine-Gynx 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9064Injection Cabazitaxel Carelon (Sandoz) Not Therapeutically Equivalent To J9043 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9118Injection Calaspargase Pegol-Carelon Mknl 10 Units2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9119Injection Cemiplimab-Rwlc 1 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9144Injection Daratumumab 10 Carelon Mg And Hyaluronidase-Fihj2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9145Injection Daratumumab 10 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9153Injection Liposomal 1 Mg Carelon Daunorubicin And 2.27 Mg Cytarabine2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9161Lymphir (denileukin diftitox- Carelon cxdl)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9173Injection Durvalumab 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9176Injection Elotuzumab 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9177Injection Enfortumab Vedotin-Carelon Ejfv 0.25 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9179Injection Eribulin Mesylate Carelon 0.1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9183Inlexzo (gemcitabine Carelon intravesical system)2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 18 Original policy
J9203Injection Gemtuzumab Carelon Ozogamicin 0.1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9204Injection Mogamulizumab- Carelon Kpkc 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9205Injection Irinotecan Carelon Liposome 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9207Injection Ixabepilone 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9223Injection Lurbinectedin 0.1 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9227Injection Isatuximab-Irfc 10 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9228Injection Ipilimumab 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9229Injection Inotuzumab Carelon Ozogamicin 0.1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9256Imaavy (nipocalimab-aahu) BCBSMT2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9264Injection Paclitaxel Protein- Carelon Bound Particles 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9266Injection Pegaspargase Per Carelon Single Dose Vial2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9269Injection Tagraxofusp-Erzs Carelon 10 Micrograms2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9271Injection Pembrolizumab 1 Carelon Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9272Injection Dostarlimab-Gxly Carelon 10 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9273Injection Tisotumab Vedotin- Carelon Tftv 1 Mg2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 Original policy
J9274Injection Tebentafusp-Tebn 1 Carelon Microgram2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 19 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.

This website uses cookies to ensure you get the best experience on our website. Learn more