Blue Cross and Blue Shield of Montana prior authorization, page 39
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
| Code | Description | Source |
|---|---|---|
| Q5157 | Injection, denosumab-bmwo Carelon (stoboclo/osenvelt), biosimilar, 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5158 | Injection, denosumab-bnht Carelon (bomyntra/conexxence), biosimilar, 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5159 | Injection, denosumab-dssb Carelon (ospomyv/xbryk), biosimilar, 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5160 | bevacizumab-nwgd | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5161 | Bosaya/Aukelso (denosumab- Carelon kyqq) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5162 | Bildyos/Bilprevda Carelon (denosumab-nxxp) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5164 | Starjemza (ustekinumab- BCBSMT hmny) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 29 Original policy |
| Q5165 | Oziltus (denosumab-mobz) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5166 | Osvyrti/Jubereq (denosumab- Carelon desu) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5167 | Enoby/Xtrenbo (denosumab- Carelon qbde) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5169 | Armlupeg (pegfilgrastim- Carelon unne) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5171 | Boncresa (denosumab-mobz) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5172 | Filkri (filgrastim-laha) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q5173 | Ponlimsi (denosumab-adet) | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q9997 | Injection, ustekinumab-ttwe BCBSMT (pyzchiva), intravenous, 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q9998 | Injection, ustekinumab-aekn BCBSMT (selarsdi), 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |
| Q9999 | Injection, ustekinumab-aauz BCBSMT (otulfi), biosimilar, 1 mg | 2026 Specialty Drugs and Infusion Site of Care Prior Authorization Code List, Pg 30 Original policy |