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Blue Cross and Blue Shield of Montana prior authorization, page 9

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
70450Computed Tomography Head Or Brain; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70460Computed Tomography Head Or Brain; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70470Computed Tomography Head Or Brain; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70471Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70472Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70473Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed without concurrent CT or CT angiography of the same anatomy2026 Commercial Medical Surgical Prior Authorization Code List, Pg 71 Original policy
70480Computed Tomography Orbit Sella Or Posterior Fossa Or Outer Middle Or Inner Ear; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70481Computed Tomography Orbit Sella Or Posterior Fossa Or Outer Middle Or Inner Ear; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70482Computed Tomography Orbit Sella Or Posterior Fossa Or Outer Middle Or Inner Ear; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70486Computed Tomography Maxillofacial Area; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70487Computed Tomography Maxillofacial Area; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70488Computed Tomography Maxillofacial Area; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70490Computed Tomography Soft Tissue Neck; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70491Computed Tomography Soft Tissue Neck; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70492Computed Tomography Soft Tissue Neck; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 72 Original policy
70496Computed Tomographic Angiography Head With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70498Computed Tomographic Angiography Neck With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70540Magnetic Resonance (Eg Proton) Imaging Orbit Face And/Or Neck; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70542Magnetic Resonance (Eg Proton) Imaging Orbit Face And/Or Neck; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70543Magnetic Resonance (Eg Proton) Imaging Orbit Face And/Or Neck; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70544Magnetic Resonance Angiography Head; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70545Magnetic Resonance Angiography Head; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70546Magnetic Resonance Angiography Head; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70547Magnetic Resonance Angiography Neck; Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 73 Original policy
70548Magnetic Resonance Angiography Neck; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70549Magnetic Resonance Angiography Neck; Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70551Magnetic Resonance (Eg Proton) Imaging Brain (Including Brain Stem); Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70552Magnetic Resonance (Eg Proton) Imaging Brain (Including Brain Stem); With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70553Magnetic Resonance (Eg Proton) Imaging Brain (Including Brain Stem); Without Contrast Material Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70554Magnetic Resonance Imaging Brain Functional Mri; Including Test Selection And Administration Of Repetitive Body Part Movement And/Or Visual Stimulation Not Requiring Physician Or Psychologist Administration2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
70555Magnetic Resonance Imaging Brain Functional Mri; Requiring Physician Or Psychologist Administration Of Entire Neurofunctional Testing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
71250Computed Tomography Thorax Diagnostic; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 74 Original policy
71260Computed Tomography Thorax Diagnostic; With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71270Computed Tomography Thorax Diagnostic; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71271Computed Tomography Thorax Low Dose For Lung Cancer Screening Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71275Computed Tomographic Angiography Chest (Noncoronary) With Contrast Material(S) Including Noncontrast Images If Performed And Image Postprocessing2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71550Magnetic Resonance (Eg Proton) Imaging Chest (Eg For Evaluation Of Hilar And Mediastinal Lymphadenopathy); Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71551Magnetic Resonance (Eg Proton) Imaging Chest (Eg For Evaluation Of Hilar And Mediastinal Lymphadenopathy); With Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 75 Original policy
71552Magnetic Resonance (Eg Proton) Imaging Chest (Eg For Evaluation Of Hilar And Mediastinal Lymphadenopathy); Without Contrast Material(S) Followed By Contrast Material(S) And Further Sequences2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
71555Magnetic Resonance Angiography Chest (Excluding Myocardium) With Or Without Contrast Material(S)2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72125Computed Tomography Cervical Spine; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72126Computed Tomography Cervical Spine; With Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72127Computed Tomography Cervical Spine; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72128Computed Tomography Thoracic Spine; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72129Computed Tomography Thoracic Spine; With Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72130Computed Tomography Thoracic Spine; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72131Computed Tomography Lumbar Spine; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72132Computed Tomography Lumbar Spine; With Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 76 Original policy
72133Computed Tomography Lumbar Spine; Without Contrast Material Followed By Contrast Material(S) And Further Sections2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 Original policy
72141Magnetic Resonance (Eg Proton) Imaging Spinal Canal And Contents Cervical; Without Contrast Material2026 Commercial Medical Surgical Prior Authorization Code List, Pg 77 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.

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