Blue Cross Blue Shield Oklahoma prior authorization, page 15
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 |
|---|---|---|
| 0218U | Neurology (Muscular Dystrophy) Dmd Gene Sequence Analysis Including Small Sequence Changes Deletions Duplications And Variants In Non-Uniquely Mappable Regions Blood Or Saliva Identification And Characterization Of Genetic Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 115 Original policy |
| 0228U | Oncology (Prostate) Multianalyte Molecular Profile By Photometric Detection Of Macromolecules Adsorbed On Nanosponge Array Slides With Machine Learning Utilizing First Morning Voided Urine Algorithm Reported As Likelihood Of Prostate Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 115 Original policy |
| 0229U | Bcat1 (Branched Chain Amino Acid Transaminase 1) And Ikzf1 (Ikaros Family Zinc Finger 1) (Eg Colorectal Cancer) Promoter Methylation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 115 Original policy |
| 0230U | Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Full Sequence Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Short Tandem Repeat (Str) Expansions Mobile Element Insertions And Variants In Non-Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 115 Original policy |
| 0231U | Cacna1A (Calcium Voltage-Gated Channel Subunit Alpha 1A) (Eg Spinocerebellar Ataxia) Full Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Short Tandem Repeat (Str) Gene Expansions Mobile Element Insertions And Variants In Non- Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 116 Original policy |
| 0232U | Cstb (Cystatin B) (Eg Progressive Myoclonic Epilepsy Type 1A Unverricht-Lundborg Disease) Full Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Short Tandem Repeat (Str) Expansions Mobile Element Insertions And Variants In Non- Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 116 Original policy |
| 0233U | Fxn (Frataxin) (Eg Friedreich Ataxia) Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Short Tandem Repeat (Str) Expansions Mobile Element Insertions And Variants In Non- Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 116 Original policy |
| 0234U | Mecp2 (Methyl Cpg Binding Protein 2) (Eg Rett Syndrome) Full Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Mobile Element Insertions And Variants In Non-Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 116 Original policy |
| 0235U | Pten (Phosphatase And Tensin Homolog) (Eg Cowden Syndrome Pten Hamartoma Tumor Syndrome) Full Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Mobile Element Insertions And Variants In Non- Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 117 Original policy |
| 0236U | Smn1 (Survival Of Motor Neuron 1 Telomeric) And Smn2 (Survival Of Motor Neuron 2 Centromeric) (Eg Spinal Muscular Atrophy) Full Gene Analysis Including Small Sequence Changes In Exonic And Intronic Regions Duplications Deletions And Mobile Element Insertions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 117 Original policy |
| 0237U | Cardiac Ion Channelopathies (Eg Brugada Syndrome Long Qt Syndrome Short Qt Syndrome Catecholaminergic Polymorphic Ventricular Tachycardia) Genomic Sequence Analysis Panel Including Ank2 Casq2 Cav3 Kcne1 Kcne2 Kcnh2 Kcnj2 Kcnq1 Ryr2 And Scn5A Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Mobile Element Insertions And Variants In Non-Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 117 Original policy |
| 0238U | Oncology (Lynch Syndrome) Genomic Dna Sequence Analysis Of Mlh1 Msh2 Msh6 Pms2 And Epcam Including Small Sequence Changes In Exonic And Intronic Regions Deletions Duplications Mobile Element Insertions And Variants In Non-Uniquely Mappable Regions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 118 Original policy |
| 0239U | Targeted Genomic Sequence Analysis Panel Solid Organ Neoplasm Cell-Free Dna Analysis Of 311 Or More Genes Interrogation For Sequence Variants Including Substitutions Insertions Deletions Select Rearrangements And Copy Number Variations | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 118 Original policy |
| 0242U | Targeted Genomic Sequence Analysis Panel Solid Organ Neoplasm Cell-Free Circulating Dna Analysis Of 55-74 Genes Interrogation For Sequence Variants Gene Copy Number Amplifications And Gene Rearrangements | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 118 Original policy |
| 0244U | Oncology (Solid Organ) Dna Comprehensive Genomic Profiling 257 Genes Interrogation For Single- Nucleotide Variants Insertions/Deletions Copy Number Alterations Gene Rearrangements Tumor-Mutational Burden And Microsatellite Instability Utilizing Formalin-Fixed Paraffin-Embedded Tumor Tissue | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 118 Original policy |
| 0245U | Oncology (Thyroid) Mutation Analysis Of 10 Genes And 37 Rna Fusions And Expression Of 4 Mrna Markers Using Next-Generation Sequencing Fine Needle Aspirate Report Includes Associated Risk Of Malignancy Expressed As A Percentage | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 119 Original policy |
| 0250U | Oncology (Solid Organ Neoplasm) Targeted Genomic Sequence Dna Analysis Of 505 Genes Interrogation For Somatic Alterations (Snvs [Single Nucleotide Variant] Small Insertions And Deletions One Amplification And Four Translocations) Microsatellite Instability And Tumor-Mutation Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 119 Original policy |
| 0252U | Fetal Aneuploidy Short Tandem-Repeat Comparative Analysis Fetal Dna From Products Of Conception Reported As Normal (Euploidy) Monosomy Trisomy Or Partial Deletion/Duplication Mosaicism And Segmental Aneuploidy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 119 Original policy |
| 0253U | Reproductive Medicine (Endometrial Receptivity Analysis) Rna Gene Expression Profile 238 Genes By Next-Generation Sequencing Endometrial Tissue Predictive Algorithm Reported As Endometrial Window Of Implantation (Eg Pre- Receptive Receptive Post- Receptive) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 119 Original policy |
| 0254U | Reproductive Medicine (Preimplantation Genetic Assessment) Analysis Of 24 Chromosomes Using Embryonic Dna Genomic Sequence Analysis For Aneuploidy And A Mitochondrial Dna Score In Euploid Embryos Results Reported As Normal (Euploidy) Monosomy Trisomy Or Partial Deletion/Duplication Mosaicism And Segmental Aneuploidy Per Embryo Tested | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 120 Original policy |
| 0258U | Autoimmune (Psoriasis) Mrna Next- Generation Sequencing Gene Expression Profiling Of 50-100 Genes Skin-Surface Collection Using Adhesive Patch Algorithm Reported As Likelihood Of Response To Psoriasis Biologics | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 120 Original policy |
| 0260U | Rare Diseases (Constitutional/Heritable Disorders) Identification Of Copy Number Variations Inversions Insertions Translocations And Other Structural Variants By Optical Genome Mapping | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 120 Original policy |
| 0262U | Oncology (Solid Tumor) Gene Expression Profiling By Real-Time Rt- Pcr Of 7 Gene Pathways (Er Ar Pi3K Mapk Hh Tgfb Notch) Formalin-Fixed Paraffin-Embedded (Ffpe) Algorithm Reported As Gene Pathway Activity Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 120 Original policy |
| 0264U | Rare Diseases (Constitutional/Heritable Disorders) Identification Of Copy Number Variations Inversions Insertions Translocations And Other Structural Variants By Optical Genome Mapping | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 121 Original policy |
| 0265U | Rare Constitutional And Other Heritable Disorders Whole Genome And Mitochondrial Dna Sequence Analysis Blood Frozen And Formalin-Fixed Paraffin-Embedded (Ffpe) Tissue Saliva Buccal Swabs Or Cell Lines Identification Of Single Nucleotide And Copy Number Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 121 Original policy |
| 0266U | Unexplained Constitutional Or Other Heritable Disorders Or Syndromes Tissue-Specific Gene Expression By Whole-Transcriptome And Next- Generation Sequencing Blood Formalin-Fixed Paraffin-Embedded (Ffpe) Tissue Or Fresh Frozen Tissue Reported As Presence Or Absence Of Splicing Or Expression Changes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 121 Original policy |
| 0267U | Rare Constitutional And Other Heritable Disorders Identification Of Copy Number Variations Inversions Insertions Translocations And Other Structural Variants By Optical Genome Mapping And Whole Genome Sequencing | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 121 Original policy |
| 0268U | Hematology (Atypical Hemolytic Uremic Syndrome [Ahus]) Genomic Sequence Analysis Of 15 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 121 Original policy |
| 0269U | Hematology (Autosomal Dominant Congenital Thrombocytopenia) Genomic Sequence Analysis Of 22 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0270U | Hematology (Congenital Coagulation Disorders) Genomic Sequence Analysis Of 20 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0271U | Hematology (Congenital Neutropenia) Genomic Sequence Analysis Of 24 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0272U | Hematology (Genetic Bleeding Disorders) Genomic Sequence Analysis Of 60 Genes And Duplication/Deletion Of Plau Blood Buccal Swab Or Amniotic Fluid Comprehensive | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0273U | Hematology (Genetic Hyperfibrinolysis Delayed Bleeding) Genomic Sequence Analysis Of 8 Genes (F13A1 F13B Fga Fgb Fgg Serpina1 Serpine1 Serpinf2 Plau) Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0274U | Hematology (Genetic Platelet Disorders) Genomic Sequence Analysis Of 62 Genes And Duplication/Deletion Of Plau Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0276U | Hematology (Inherited Thrombocytopenia) Genomic Sequence Analysis Of 42 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 122 Original policy |
| 0277U | Hematology (Genetic Platelet Function Disorder) Genomic Sequence Analysis Of 40 Genes And Duplication/Deletion Of Plau Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 123 Original policy |
| 0278U | Hematology (Genetic Thrombosis) Genomic Sequence Analysis Of 14 Genes Blood Buccal Swab Or Amniotic Fluid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 123 Original policy |
| 0285U | Oncology Response To Radiation Cell-Free Dna Quantitative Branched Chain Dna Amplification Plasma Reported As A Radiation Toxicity Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 123 Original policy |
| 0286U | Cep72 (Centrosomal Protein 72- Kda) Nudt15 (Nudix Hydrolase 15) And Tpmt (Thiopurine S- Methyltransferase) (Eg Drug Metabolism) Gene Analysis Common Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 123 Original policy |
| 0287U | Oncology (Thyroid) Dna And Mrna Next-Generation Sequencing Analysis Of 112 Genes Fine Needle Aspirate Or Formalin-Fixed Paraffin- Embedded (Ffpe) Tissue Algorithmic Prediction Of Cancer Recurrence Reported As A Categorical Risk Result (Low Intermediate High) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 123 Original policy |
| 0288U | Oncology (Lung) Mrna Quantitative Pcr Analysis Of 11 Genes (Bag1 Brca1 Cdc6 Cdk2Ap1 Erbb3 Fut3 Il11 Lck Rnd3 Sh3Bgr Wnt3A) And 3 Reference Genes (Esd Tbp Yap1) Formalin-Fixed Paraffin- Embedded (Ffpe) Tumor Tissue Algorithmic Interpretation Reported As A Recurrence Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0289U | Neurology (Alzheimer Disease) Mrna Gene Expression Profiling By Rna Sequencing Of 24 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0290U | Pain Management Mrna Gene Expression Profiling By Rna Sequencing Of 36 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0291U | Psychiatry (Mood Disorders) Mrna Gene Expression Profiling By Rna Sequencing Of 144 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0292U | Psychiatry (Stress Disorders) Mrna Gene Expression Profiling By Rna Sequencing Of 72 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0293U | Psychiatry (Suicidal Ideation) Mrna Gene Expression Profiling By Rna Sequencing Of 54 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 124 Original policy |
| 0294U | Longevity And Mortality Risk Mrna Gene Expression Profiling By Rna Sequencing Of 18 Genes Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 125 Original policy |
| 0296U | Oncology (Oral And/Or Oropharyngeal Cancer) Gene Expression Profiling By Rna Sequencing At Least 20 Molecular Features (Eg Human And/Or Microbial Mrna) Saliva Algorithm Reported As Positive Or Negative For Signature Associated With Malignancy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 125 Original policy |
| 0297U | Oncology (Pan Tumor) Whole Genome Sequencing Of Paired Malignant And Normal Dna Specimens Fresh Or Formalin-Fixed Paraffin-Embedded (Ffpe) Tissue Blood Or Bone Marrow Comparative Sequence Analyses And Variant Identification | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 125 Original policy |
| 0298U | Oncology (Pan Tumor) Whole Transcriptome Sequencing Of Paired Malignant And Normal Rna Specimens Fresh Or Formalin-Fixed Paraffin-Embedded (Ffpe) Tissue Blood Or Bone Marrow Comparative Sequence Analyses And Expression Level And Chimeric Transcript Identification | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 125 Original policy |