Blue Cross Blue Shield Oklahoma prior authorization, page 16
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 |
|---|---|---|
| 0299U | Oncology (Pan Tumor) Whole Genome Optical Genome Mapping Of Paired Malignant And Normal Dna Specimens Fresh Frozen Tissue Blood Or Bone Marrow Comparative Structural Variant Identification | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 125 Original policy |
| 0300U | Oncology (Pan Tumor) Whole Genome Sequencing And Optical Genome Mapping Of Paired Malignant And Normal Dna Specimens Fresh Tissue Blood Or Bone Marrow Comparative Sequence Analyses And Variant Identification | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 126 Original policy |
| 0306U | Oncology (Minimal Residual Disease [Mrd]) Next-Generation Targeted Sequencing Analysis Cell-Free Dna Initial (Baseline) Assessment To Determine A Patient Specific Panel For Future Comparisons To Evaluate For Mrd | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 126 Original policy |
| 0307U | Oncology (Minimal Residual Disease [Mrd]) Next-Generation Targeted Sequencing Analysis Of A Patient- Specific Panel Cell-Free Dna Subsequent Assessment With Comparison To Previously Analyzed Patient Specimens To Evaluate For Mrd | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 126 Original policy |
| 0313U | Oncology (Pancreas) Dna And Mrna Next-Generation Sequencing Analysis Of 74 Genes And Analysis Of Cea (Ceacam5) Gene Expression Pancreatic Cyst Fluid Algorithm Reported As A Categorical Result (Ie Negative Low Probability Of Neoplasia Or Positive High Probability Of Neoplasia) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 126 Original policy |
| 0314U | Oncology (Cutaneous Melanoma) Mrna Gene Expression Profiling By Rt-Pcr Of 35 Genes (32 Content And 3 Housekeeping) Utilizing Formalin- Fixed Paraffin-Embedded (Ffpe) Tissue Algorithm Reported As A Categorical Result (Ie Benign Intermediate Malignant) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 127 Original policy |
| 0315U | Oncology (Cutaneous Squamous Cell Carcinoma) Mrna Gene Expression Profiling By Rt-Pcr Of 40 Genes (34 Content And 6 Housekeeping) Utilizing Formalin- Fixed Paraffin-Embedded (Ffpe) Tissue Algorithm Reported As A Categorical Risk Result (Ie Class 1 Class 2A Class 2B) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 127 Original policy |
| 0317U | Oncology (Lung Cancer) Four-Probe Fish (3Q29 3P22.1 10Q22.3 10Cen) Assay Whole Blood Predictive Algorithmgenerated Evaluation Reported As Decreased Or Increased Risk For Lung Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 127 Original policy |
| 0318U | Pediatrics (Congenital Epigenetic Disorders) Whole Genome Methylation Analysis By Microarray For 50 Or More Genes Blood | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 127 Original policy |
| 0319U | Nephrology (Renal Transplant) Rna Expression By Select Transcriptome Sequencing Using Pretransplant Peripheral Blood Algorithm Reported As A Risk Score For Early Acute Rejection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 127 Original policy |
| 0320U | Nephrology (Renal Transplant) Rna Expression By Select Transcriptome Sequencing Using Posttransplant Peripheral Blood Algorithm Reported As A Risk Score For Acute Cellular Rejection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 128 Original policy |
| 0326U | Targeted Genomic Sequence Analysis Panel Solid Organ Neoplasm Cell-Free Circulating Dna Analysis Of 83 Or More Genes Interrogation For Sequence Variants Gene Copy Number Amplifications Gene Rearrangements Microsatellite Instability And Tumor Mutational Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 128 Original policy |
| 0327U | Fetal Aneuploidy (Trisomy 13 18 And 21) Dna Sequence Analysis Of Selected Regions Using Maternal Plasma Algorithm Reported As A Risk Score For Each Trisomy Includes Sex Reporting If Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 128 Original policy |
| 0329U | Oncology (Neoplasia) Exome And Transcriptome Sequence Analysis For Sequence Variants Gene Copy Number Amplifications And Deletions Gene Rearrangements Microsatellite Instability And Tumor Mutational Burden Utilizing Dna And Rna From Tumor With Dna From Normal Blood Or Saliva For Subtraction Report Of Clinically Significant Mutation(S) With Therapy Associations | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 128 Original policy |
| 0331U | Oncology (Hematolymphoid Neoplasia) Optical Genome Mapping For Copy Number Alterations And Gene Rearrangements Utilizing Dna From Blood Or Bone Marrow Report Of Clinically Significant Alternations | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 129 Original policy |
| 0332U | Oncology (Pan-Tumor) Genetic Profiling Of 8 Dna-Regulatory (Epigenetic) Markers By Quantitative Polymerase Chain Reaction (Qpcr) Whole Blood Reported As A High Or Low Probability Of Responding To Immune Checkpoint-Inhibitor Therapy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 129 Original policy |
| 0333U | Oncology (Liver) Surveillance For Hepatocellular Carcinoma (Hcc) In Highrisk Patients Analysis Of Methylation Patterns On Circulating Cell-Free Dna (Cfdna) Plus Measurement Of Serum Of Afp/Afp- L3 And Oncoprotein Des- Gammacarboxy-Prothrombin (Dcp) Algorithm Reported As Normal Or Abnormal Result | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 129 Original policy |
| 0334U | Oncology (Solid Organ) Targeted Genomic Sequence Analysis Formalin-Fixed Paraffinembedded (Ffpe) Tumor Tissue Dna Analysis 84 Or More Genes Interrogation For Sequence Variants Gene Copy Number Amplifications Gene Rearrangements Microsatellite Instability And Tumor Mutational Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 129 Original policy |
| 0335U | Rare Diseases (Constitutional/Heritable Disorders) Whole Genome Sequence Analysis Including Small Sequence Changes Copy Number Variants Deletions Duplications Mobile Element Insertions Uniparental Disomy (Upd) Inversions Aneuploidy Mitochondrial Genome Sequence Analysis With Heteroplasmy And Large Deletions Short Tandem Repeat (Str) Gene Expansions Fetal Sample Identification And Categorization Of Genetic Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 130 Original policy |
| 0336U | Rare Diseases (Constitutional/Heritable Disorders) Whole Genome Sequence Analysis Including Small Sequence Changes Copy Number Variants Deletions Duplications Mobile Element Insertions Uniparental Disomy (Upd) Inversions Aneuploidy Mitochondrial Genome Sequence Analysis With Heteroplasmy And Large Deletions Short Tandem Repeat (Str) Gene Expansions Blood Or Saliva Identification And Categorization Of Genetic Variants Each Comparator Genome (Eg Parent) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 130 Original policy |
| 0339U | Oncology (Prostate) Mrna Expression Profiling Of Hoxc6 And Dlx1 Reverse Transcription Polymerase Chain Reaction (Rt-Pcr) First-Void Urine Following Digital Rectal Examination Algorithm Reported As Probability Of High- Grade Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 130 Original policy |
| 0340U | Oncology (Pan-Cancer) Analysis Of Minimal Residual Disease (Mrd) From Plasma With Assays Personalized To Each Patient Based On Prior Next-Generation Sequencing Of The Patient’S Tumor And Germline Dna Reported As Absence Or Presence Of Mrd With Disease-Burden Correlation If Appropriate | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 131 Original policy |
| 0341U | Fetal Aneuploidy Dna Sequencing Comparative Analysis Fetal Dna From Products Of Conception Reported As Normal (Euploidy) Monosomy Trisomy Or Partial Deletion/Duplication Mosaicism And Segmental Aneuploid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 131 Original policy |
| 0343U | Oncology (Prostate) Exosome- Based Analysis Of 442 Small Noncoding Rnas (Sncrnas) By Quantitative Reverse Transcription Polymerase Chain Reaction (Rt- Qpcr) Urine Reported As Molecular Evidence Of No- Low- Intermediate- Or High-Risk Of Prostate Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 131 Original policy |
| 0345U | Psychiatry (Eg Depression Anxiety Attention Deficit Hyperactivity Disorder [Adhd]) Genomic Analysis Panel Variant Analysis Of 15 Genes Including Deletion/Duplication Analysis Of Cyp2D6 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 131 Original policy |
| 0347U | Drug Metabolism Or Processing (Multiple Conditions) Whole Blood Or Buccal Specimen Dna Analysis 16 Gene Report With Variant Analysis And Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 131 Original policy |
| 0348U | Drug Metabolism Or Processing (Multiple Conditions) Whole Blood Or Buccal Specimen Dna Analysis 25 Gene Report With Variant Analysis And Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0349U | Drug Metabolism Or Processing (Multiple Conditions) Whole Blood Or Buccal Specimen Dna Analysis 27 Gene Report With Variant Analysis Including Reported Phenotypes And Impacted Gene- Drug Interactions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0350U | Drug Metabolism Or Processing (Multiple Conditions) Whole Blood Or Buccal Specimen Dna Analysis 27 Gene Report With Variant Analysis And Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0355U | Apol1 (Apolipoprotein L1) (Eg Chronic Kidney Disease) Risk Variants (G1 G2) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0356U | Oncology (Oropharyngeal Or Anal) Evaluation Of 17 Dna Biomarkers Using Droplet Digital Pcr (Ddpcr) Cell-Free Dna Algorithm Reported As A Prognostic Risk Score For Cancer Recurrence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0362U | Oncology (Papillary Thyroid Cancer) Gene-Expression Profiling Via Targeted Hybrid Capture- Enrichment Rna Sequencing Of 82 Content Genes And 10 Housekeeping Genes Fine Needle Aspirate Or Formalin-Fixed Paraffinembedded (Ffpe) Tissue Algorithm Reported As One Of Three Molecular Subtypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 132 Original policy |
| 0363U | Oncology (Urothelial) Mrna Gene- Expression Profiling By Real-Time Quantitative Pcr Of 5 Genes (Mdk Hoxa13 Cdc2 [Cdk1] Igfbp5 And Cxcr2) Utilizing Urine Algorithm Incorporates Age Sex Smoking History And Macrohematuria Frequency Reported As A Risk Score For Having Urothelial Carcinoma | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 133 Original policy |
| 0364U | Oncology (Hematolymphoid Neoplasm) Genomic Sequence Analysis Using Multiplex (Pcr) And Next-Generation Sequencing With Algorithm Quantification Of Dominant Clonal Sequence(S) Reported As Presence Or Absence Of Minimal Residual Disease (Mrd) With Quantitation Of Disease Burden When Appropriate | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 133 Original policy |
| 0368U | Oncology (Colorectal Cancer) Evaluation For Mutations Of Apc Braf Ctnnb1 Kras Nras Pik3Ca Smad4 And Tp53 And Methylation Markers (Myo1G Kcnq5 C9Orf50 Fli1 Clip4 Znf132 And Twist1) Multiplex Quantitative Polymerase Chain Reaction (Qpcr) Circulating Cell-Free Dna (Cfdna) Plasma Report Of Risk Score For Advanced Adenoma Or Colorectal Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 133 Original policy |
| 0378U | Rfc1 (Replication Factor C Subunit 1) Repeat Expansion Variant Analysis By Traditional And Repeat- Primed Pcr Blood Saliva Or Buccal Swab | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 133 Original policy |
| 0379U | Targeted Genomic Sequence Analysis Panel Solid Organ Neoplasm Dna (523 Genes) And Rna (55 Genes) By Nextgeneration Sequencing Interrogation For Sequence Variants Gene Copy Number Amplifications Gene Rearrangements Microsatellite Instability And Tumor Mutational Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 134 Original policy |
| 0380U | Drug Metabolism (Adverse Drug Reactions And Drug Response) Targeted Sequence Analysis 20 Gene Variants And Cyp2D6 Deletion Or Duplication Analysis With Reported Genotype And Phenotype | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 134 Original policy |
| 0388U | Oncology (Non-Small Cell Lung Cancer) Next-Generation Sequencing With Identification Of Single Nucleotide Variants Copy Number Variants Insertions And Deletions And Structural Variants In 37 Cancer-Related Genes Plasma With Report For Alteration Detection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 134 Original policy |
| 0389U | Pediatric Febrile Illness (Kawasaki Disease [Kd]) Interferon Alphainducible Protein 27 (Ifi27) And Mast Cell-Expressed Membrane Protein 1 (Mcemp1) Rna Using Reverse Transcription Polymerase Chain Reaction (Rt-Qpcr) Blood Reported As A Risk Score For Kd | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 134 Original policy |
| 0391U | Oncology (Solid Tumor) Dna And Rna By Next-Generation Sequencing Utilizing Formalin-Fixed Paraffin- Embedded (Ffpe) Tissue 437 Genes Interpretive Report For Single Nucleotide Variants Splicesite Variants Insertions/Deletions Copy Number Alterations Gene Fusions Tumor Mutational Burden And Microsatellite Instability With Algorithm Quantifying Immunotherapy Response Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 135 Original policy |
| 0392U | Drug Metabolism (Depression Anxiety Attention Deficit Hyperactivity Disorder [Adhd]) Gene- Drug Interactions Variant Analysis Of 16 Genes Including Deletion/Duplication Analysis Of Cyp2D6 Reported As Impact Of Gene-Drug Interaction For Each Drug | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 135 Original policy |
| 0396U | Obstetrics (Pre-Implantation Genetic Testing) Evaluation Of 300000 Dna Single-Nucleotide Polymorphisms (Snps) By Microarray Embryonic Tissue Algorithm Reported As A Probability For Single-Gene Germline Conditions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 135 Original policy |
| 0400U | Obstetrics (Expanded Carrier Screening) 145 Genes By Nextgeneration Sequencing Fragment Analysis And Multiplex Ligationdependent Probe Amplification Dna Reported As Carrier Positive Or Negative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 135 Original policy |
| 0401U | Cardiology (Coronary Heart Disease [Cad]) 9 Genes (12 Variants) Targeted Variant Genotyping Blood Saliva Or Buccal Swab Algorithm Reported As A Genetic Risk Score For A Coronary Event | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0403U | Onc Prst8 Mrna 18 Gen Dre Ur | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0405U | Oncology (Pancreatic) 59 Methylation Haplotype Block Markers Next-Generation Sequencing Plasma Reported As Cancer Signal Detected Or Not Detected | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0409U | Onc Sld Tum Dna 80 & Rna 36 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0410U | Oncology (Pancreatic) Dna Whole Genome Sequencing With 5- Hydroxymethylcytosine Enrichment Whole Blood Or Plasma Algorithm Reported As Cancer Detected Or Not Detected | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0411U | Psychiatry (Eg Depression Anxiety Attention Deficit Hyperactivity Disorder [Adhd]) Genomic Analysis Panel Variant Analysis Of 15 Genes Including Deletion/Duplication Analysis Of Cyp2D6 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |