Blue Cross Blue Shield Oklahoma prior authorization, page 10
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 |
|---|---|---|
| 81272 | Kit (V-Kit Hardy-Zuckerman 4 Feline Sarcoma Viral Oncogene Homolog) (Eg Gastrointestinal Stromal Tumor [Gist] Acute Myeloid Leukemia Melanoma) Gene Analysis Targeted Sequence Analysis (Eg Exons 8 11 13 17 18) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81273 | Kit (V-Kit Hardy-Zuckerman 4 Feline Sarcoma Viral Oncogene Homolog) (Eg Mastocytosis) Gene Analysis D816 Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81274 | Htt (Huntingtin) (Eg Huntington Disease) Gene Analysis; Characterization Of Alleles (Eg Expanded Size) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81275 | Kras (Kirsten Rat Sarcoma Viral Oncogene Homolog) (Eg Carcinoma) Gene Analysis; Variants In Exon 2 (Eg Codons 12 And 13) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81276 | Kras (Kirsten Rat Sarcoma Viral Oncogene Homolog) (Eg Carcinoma) Gene Analysis; Additional Variant(S) (Eg Codon 61 Codon 146) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81277 | Cytogenomic Neoplasia (Genome- Wide) Microarray Analysis Interrogation Of Genomic Regions For Copy Number And Loss-Of- Heterozygosity Variants For Chromosomal Abnormalities | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |
| 81278 | Igh@/Bcl2 (T(14;18)) (Eg Follicular Lymphoma) Translocation Analysis Major Breakpoint Region (Mbr) And Minor Cluster Region (Mcr) Breakpoints Qualitative Or Quantitative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81279 | Jak2 (Janus Kinase 2) (Eg Myeloproliferative Disorder) Targeted Sequence Analysis (Eg Exons 12 And 13) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81283 | Ifnl3 (Interferon Lambda 3) (Eg Drug Response) Gene Analysis Rs12979860 Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81284 | Fxn (Frataxin) (Eg Friedreich Ataxia) Gene Analysis; Evaluation To Detect Abnormal (Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81285 | Fxn (Frataxin) (Eg Friedreich Ataxia) Gene Analysis; Characterization Of Alleles (Eg Expanded Size) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81286 | Fxn (Frataxin) (Eg Friedreich Ataxia) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81287 | Mgmt (O-6-Methylguanine-Dna Methyltransferase) (Eg Glioblastoma Multiforme) Promoter Methylation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81288 | Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Promoter Methylation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81289 | Fxn (Frataxin) (Eg Friedreich Ataxia) Gene Analysis; Known Familial Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81290 | Mcoln1 (Mucolipin 1) (Eg Mucolipidosis Type Iv) Gene Analysis Common Variants (Eg Ivs3-2A>G Del6.4Kb) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 61 Original policy |
| 81291 | Mthfr (5 10- Methylenetetrahydrofolate Reductase) (Eg Hereditary Hypercoagulability) Gene Analysis Common Variants (Eg 677T 1298C) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81292 | Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81293 | Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81294 | Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81295 | Msh2 (Muts Homolog 2 Colon Cancer Nonpolyposis Type 1) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81296 | Msh2 (Muts Homolog 2 Colon Cancer Nonpolyposis Type 1) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81297 | Msh2 (Muts Homolog 2 Colon Cancer Nonpolyposis Type 1) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 62 Original policy |
| 81298 | Msh6 (Muts Homolog 6 [E. Coli]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81299 | Msh6 (Muts Homolog 6 [E. Coli]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81300 | Msh6 (Muts Homolog 6 [E. Coli]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81301 | Microsatellite Instability Analysis (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Of Markers For Mismatch Repair Deficiency (Eg Bat25 Bat26) Includes Comparison Of Neoplastic And Normal Tissue If Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81302 | Mecp2 (Methyl Cpg Binding Protein 2) (Eg Rett Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81303 | Mecp2 (Methyl Cpg Binding Protein 2) (Eg Rett Syndrome) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81304 | Mecp2 (Methyl Cpg Binding Protein 2) (Eg Rett Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81305 | Myd88 (Myeloid Differentiation Primary Response 88) (Eg Waldenstrom'S Macroglobulinemia Lymphoplasmacytic Leukemia) Gene Analysis P.Leu265Pro (L265P) Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 63 Original policy |
| 81306 | Nudt15 (Nudix Hydrolase 15) (Eg Drug Metabolism) Gene Analysis Common Variant(S) (Eg *2 *3 *4 *5 *6) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81307 | Palb2 (Partner And Localizer Of Brca2) (Eg Breast And Pancreatic Cancer) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81308 | Palb2 (Partner And Localizer Of Brca2) (Eg Breast And Pancreatic Cancer) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81309 | Pik3Ca (Phosphatidylinositol-4 5- Biphosphate 3-Kinase Catalytic Subunit Alpha) (Eg Colorectal And Breast Cancer) Gene Analysis Targeted Sequence Analysis (Eg Exons 7 9 20) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81310 | Npm1 (Nucleophosmin) (Eg Acute Myeloid Leukemia) Gene Analysis Exon 12 Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81311 | Nras (Neuroblastoma Ras Viral [V- Ras] Oncogene Homolog) (Eg Colorectal Carcinoma) Gene Analysis Variants In Exon 2 (Eg Codons 12 And 13) And Exon 3 (Eg Codon 61) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81312 | Pabpn1 (Poly[A] Binding Protein Nuclear 1) (Eg Oculopharyngeal Muscular Dystrophy) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81313 | Pca3/Klk3 (Prostate Cancer Antigen 3 [Non-Protein Coding]/Kallikrein- Related Peptidase 3 [Prostate Specific Antigen]) Ratio (Eg Prostate Cancer) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 64 Original policy |
| 81314 | Pdgfra (Platelet-Derived Growth Factor Receptor Alpha Polypeptide) (Eg Gastrointestinal Stromal Tumor [Gist]) Gene Analysis Targeted Sequence Analysis (Eg Exons 12 18) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81315 | Pml/Raralpha (T(15;17)) (Promyelocytic Leukemia/Retinoic Acid Receptor Alpha) (Eg Promyelocytic Leukemia) Translocation Analysis; Common Breakpoints (Eg Intron 3 And Intron 6) Qualitative Or Quantitative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81316 | Pml/Raralpha (T(15;17)) (Promyelocytic Leukemia/Retinoic Acid Receptor Alpha) (Eg Promyelocytic Leukemia) Translocation Analysis; Single Breakpoint (Eg Intron 3 Intron 6 Or Exon 6) Qualitative Or Quantitative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81317 | Pms2 (Postmeiotic Segregation Increased 2 [S. Cerevisiae]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81318 | Pms2 (Postmeiotic Segregation Increased 2 [S. Cerevisiae]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81319 | Pms2 (Postmeiotic Segregation Increased 2 [S. Cerevisiae]) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 65 Original policy |
| 81320 | Plcg2 (Phospholipase C Gamma 2) (Eg Chronic Lymphocytic Leukemia) Gene Analysis Common Variants (Eg R665W S707F L845F) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 66 Original policy |
| 81321 | Pten (Phosphatase And Tensin Homolog) (Eg Cowden Syndrome Pten Hamartoma Tumor Syndrome) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 66 Original policy |
| 81322 | Pten (Phosphatase And Tensin Homolog) (Eg Cowden Syndrome Pten Hamartoma Tumor Syndrome) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 66 Original policy |
| 81323 | Pten (Phosphatase And Tensin Homolog) (Eg Cowden Syndrome Pten Hamartoma Tumor Syndrome) Gene Analysis; Duplication/Deletion Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 66 Original policy |
| 81324 | Pmp22 (Peripheral Myelin Protein 22) (Eg Charcot-Marie-Tooth Hereditary Neuropathy With Liability To Pressure Palsies) Gene Analysis; Duplication/Deletion Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 66 Original policy |