Blue Cross and Blue Shield of Montana prior authorization, page 7
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 |
|---|---|---|
| 63005 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) 1 Or 2 Vertebral Segments; Lumbar Except For Spondylolisthesis | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 52 Original policy |
| 63012 | Laminectomy With Removal Of Abnormal Facets And/Or Pars Inter-Articularis With Decompression Of Cauda Equina And Nerve Roots For Spondylolisthesis Lumbar (Gill Type Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 52 Original policy |
| 63015 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 52 Original policy |
| 63016 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Thoracic | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 52 Original policy |
| 63017 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 52 Original policy |
| 63020 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; 1 Interspace Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 53 Original policy |
| 63030 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; 1 Interspace Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 53 Original policy |
| 63035 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; Each Additional Interspace Cervical Or Lumbar (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 53 Original policy |
| 63040 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 53 Original policy |
| 63042 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 54 Original policy |
| 63043 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Each Additional Cervical Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 54 Original policy |
| 63044 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Each Additional Lumbar Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 54 Original policy |
| 63045 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 55 Original policy |
| 63046 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Thoracic | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 55 Original policy |
| 63047 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 55 Original policy |
| 63048 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Each Additional Vertebral Segment Cervical Thoracic Or Lumbar (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 55 Original policy |
| 63050 | Laminoplasty Cervical With Decompression Of The Spinal Cord 2 Or More Vertebral Segments | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 56 Original policy |
| 63051 | Laminoplasty Cervical With Decompression Of The Spinal Cord 2 Or More Vertebral Segments; With Reconstruction Of The Posterior Bony Elements (Including The Application Of Bridging Bone Graft And Non-Segmental Fixation Devices [Eg Wire Suture Mini- Plates] When Performed) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 56 Original policy |
| 63052 | Laminectomy Facetectomy Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) During Posterior Interbody Arthrodesis Lumbar; Single Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 56 Original policy |
| 63053 | Laminectomy Facetectomy Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) During Posterior Interbody Arthrodesis Lumbar; Each Additional Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 56 Original policy |
| 63055 | Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Thoracic | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 57 Original policy |
| 63056 | Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Lumbar (Including Transfacet Or Lateral Extraforaminal Approach) (Eg Far Lateral Herniated Intervertebral Disc) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 57 Original policy |
| 63057 | Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Each Additional Segment Thoracic Or Lumbar (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 57 Original policy |
| 63075 | Discectomy Anterior With Decompression Of Spinal Cord And/Or Nerve Root(S) Including Osteophytectomy; Cervical Single Interspace | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 57 Original policy |
| 63076 | Discectomy Anterior With Decompression Of Spinal Cord And/Or Nerve Root(S) Including Osteophytectomy; Cervical Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 58 Original policy |
| 63081 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Anterior Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Cervical Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 58 Original policy |
| 63082 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Anterior Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Cervical Each Additional Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 58 Original policy |
| 63085 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 58 Original policy |
| 63086 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic Each Additional Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 59 Original policy |
| 63087 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Combined Thoracolumbar Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar; Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 59 Original policy |
| 63088 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Combined Thoracolumbar Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar; Each Additional Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 59 Original policy |
| 63090 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transperitoneal Or Retroperitoneal Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar Or Sacral; Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 59 Original policy |
| 63091 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transperitoneal Or Retroperitoneal Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar Or Sacral; Each Additional Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 60 Original policy |
| 63101 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Thoracic Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 60 Original policy |
| 63102 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Lumbar Single Segment | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 60 Original policy |
| 63103 | Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Thoracic Or Lumbar Each Additional Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63185 | Laminectomy With Rhizotomy; 1 Or 2 Segments | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63190 | Laminectomy With Rhizotomy; More Than Segments | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63191 | Laminectomy With Section Of Spinal Accessory Nerve | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63200 | Laminectomy With Release Of Tethered Spinal Cord Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63250 | Laminectomy For Excision Or Occlusion Of Arteriovenous Malformation Of Spinal Cord; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63252 | Laminectomy For Excision Or Occlusion Of Arteriovenous Malformation Of Spinal Cord; Thoracolumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63265 | Laminectomy For Excision Or Evacuation Of Intraspinal Lesion Other Than Neoplasm Extradural; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63267 | Laminectomy For Excision Or Evacuation Of Intraspinal Lesion Other Than Neoplasm Extradural; Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 61 Original policy |
| 63270 | Laminectomy For Excision Of Intraspinal Lesion Other Than Neoplasm Intradural; Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |
| 63272 | Laminectomy For Excision Of Intraspinal Lesion Other Than Neoplasm Intradural; Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |
| 63275 | Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Extradural Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |
| 63277 | Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Extradural Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |
| 63280 | Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Extramedullary Cervical | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |
| 63282 | Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Extramedullary Lumbar | 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 62 Original policy |