Talk to Us

Blue Cross and Blue Shield of Montana prior authorization, page 4

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
22861Revision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Cervical2026 Commercial Medical Surgical Prior Authorization Code List, Pg 31 Original policy
22862Revision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Lumbar2026 Commercial Medical Surgical Prior Authorization Code List, Pg 31 Original policy
22864Removal Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Cervical2026 Commercial Medical Surgical Prior Authorization Code List, Pg 31 Original policy
22865Removal Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Lumbar2026 Commercial Medical Surgical Prior Authorization Code List, Pg 31 Original policy
27096Injection Procedure For Sacroiliac Joint Anesthetic/Steroid With Image Guidance (Fluoroscopy Or Ct) Including Arthrography When Performed2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
27279Arthrodesis Sacroiliac Joint Percutaneous Or Minimally Invasive (Indirect Visualization) With Image Guidance Includes Obtaining Bone Graft When Performed And Placement Of Transfixing Device2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
27280Arthrodesis Sacroiliac Joint Open Includes Obtaining Bone Graft Including Instrumentation When Performed2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
27415Osteochondral Allograft Knee Open2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
27416Osteochondral Autograft(S) Knee Open (Eg Mosaicplasty) (Includes Harvesting Of Autograft[S])2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
28446Open Osteochondral Autograft Talus (Includes Obtaining Graft[S])2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
29862Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum2026 Commercial Medical Surgical Prior Authorization Code List, Pg 32 Original policy
29866Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
29867Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
29868Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
29914Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
29915Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
29916Arthroscopy, hip, surgical; with labral repair2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
30120Excision Or Surgical Planing Of Skin Of Nose For Rhinophyma2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
30400Rhinoplasty Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
30410Rhinoplasty Primary; Complete External Parts Including Bony Pyramid Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
30420Rhinoplasty Primary; Including Major Septal Repair2026 Commercial Medical Surgical Prior Authorization Code List, Pg 33 Original policy
30430Rhinoplasty Secondary; Minor Revision (Small Amount Of Nasal Tip Work)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
30435Rhinoplasty Secondary; Intermediate Revision (Bony Work With Osteotomies)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
30450Rhinoplasty Secondary; Major Revision (Nasal Tip Work And Osteotomies)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
31643Bronchoscopy Rigid Or Flexible Including Fluoroscopic Guidance When Performed; With Placement Of Catheter(S) For Intracavitary Radioelement Application2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
32701Thoracic Target(S) Delineation For Stereotactic Body Radiation Therapy (Srs/Sbrt) (Photon Or Particle Beam) Entire Course Of Treatment2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
32851Lung Transplant Single; Without Cardiopulmonary Bypass2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
32852Lung Transplant Single; With Cardiopulmonary Bypass2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
32853Lung Transplant Double (Bilateral Sequential Or En Bloc); Without Cardiopulmonary Bypass2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
32854Lung Transplant Double (Bilateral Sequential Or En Bloc); With Cardiopulmonary Bypass2026 Commercial Medical Surgical Prior Authorization Code List, Pg 34 Original policy
33274Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, fe2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33285Insertion, subcutaneous cardiac rhythm monitor, including programming2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33289Transcatheter implantation of wireless pulmonary artery pressure sensor for long- term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33928Removal and replacement of total replacement heart system (artificial heart)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33935Heart-Lung Transplant With Recipient Cardiectomy-Pneumonectomy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33945Heart Transplant With Or Without Recipient Cardiectomy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
33982Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass2026 Commercial Medical Surgical Prior Authorization Code List, Pg 35 Original policy
36465Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36466Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36468Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36470Injection of sclerosant; single incompetent vein (other than telangiectasia)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36471Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36475Endovenous ablation therapy of incompetent vein, extremity, inclusive of imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated2026 Commercial Medical Surgical Prior Authorization Code List, Pg 36 Original policy
36476Endovenous ablation therapy of incompetent vein, extremity, inclusive of imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 37 Original policy
36478Endovenous ablation therapy of incompetent vein, extremity, inclusive of imaging guidance and monitoring, percutaneous, laser; first vein treated2026 Commercial Medical Surgical Prior Authorization Code List, Pg 37 Original policy
36479Endovenous ablation therapy of incompetent vein, extremity, inclusive of imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 37 Original policy
36482Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated2026 Commercial Medical Surgical Prior Authorization Code List, Pg 37 Original policy
36483Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 38 Original policy
37241Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 38 Original policy
37242Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 39 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