Blue Cross Blue Shield Oklahoma prior authorization, page 17
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 |
|---|---|---|
| 0413U | Oncology (Hematolymphoid Neoplasm) Optical Genome Mapping For Copy Number Alterations Aneuploidy And Balanced/Complex Structural Rearrangements Dna From Blood Or Bone Marrow Report Of Clinically Significant Alterations | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0414U | Onc Lng Aug Alg Aly Whl Sld8 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 136 Original policy |
| 0417U | Rare Diseases (Constitutional/Heritable Disorders) Whole Mitochondrial Genome Sequence With Heteroplasmy Detection And Deletion Analysis Nuclear-Encoded Mitochondrial Gene Analysis Of 335 Nuclear Genes Including Sequence Changes Deletions Insertions And Copy Number Variants Analysis Blood Or Saliva Identification And Categorization Of Mitochondrial Disorder-Associated Genetic Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 137 Original policy |
| 0419U | Neuropsychiatry (Eg Depression Anxiety) Genomic Sequence Analysis Panel Variant Analysis Of 13 Genes Saliva Or Buccal Swab Report Of Each Gene Phenotype | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 137 Original policy |
| 0420U | Oncology (Urothelial) Mrna Expression Profiling By Real-Time Quantitative Pcr Of Mdk Hoxa13 Cdc2 Igfbp5 And Cxcr2 In Combination With Droplet Digital Pcr (Ddpcr) Analysis Of 6 Single- Nucleotide Polymorphisms (Snps) Genes Tert And Fgfr3 Urine Algorithm Reported As A Risk Score For Urothelial Carcinoma | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 137 Original policy |
| 0422U | Oncology (Pan-Solid Tumor) Analysis Of Dna Biomarker Response To Anti-Cancer Therapy Using Cell-Free Circulating Dna Biomarker Comparison To A Previous Baseline Pre-Treatment Cell-Free Circulating Dna Analysis Using Next-Generation Sequencing Algorithm Reported As A Quantitative Change From Baseline Including Specific Alterations If Appropriate | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 138 Original policy |
| 0423U | Psychiatry (Eg Depression Anxiety) Genomic Analysis Panel Including Variant Analysis Of 26 Genes Buccal Swab Report Including Metabolizer Status And Risk Of Drug Toxicity By Condition | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 138 Original policy |
| 0424U | Oncology (Prostate) Exosomebased Analysis Of 53 Small Noncoding Rnas (Sncrnas) By Quantitative Reverse Transcription Polymerase Chain Reaction (Rtqpcr) Urine Reported As No Molecular Evidence Low- Moderate- Or Elevated-Risk Of Prostate Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 138 Original policy |
| 0425U | Genome (Eg Unexplained Constitutional Or Heritable Disorder Or Syndrome) Rapid Sequence Analysis Each Comparator Genome (Eg Parents Siblings) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 138 Original policy |
| 0426U | Genome (Eg Unexplained Constitutional Or Heritable Disorder Or Syndrome) Ultra-Rapid Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 138 Original policy |
| 0428U | Oncology (Breast) Targeted Hybrid- Capture Genomic Sequence Analysis Panel Circulating Tumor Dna (Ctdna) Analysis Of 56 Or More Genes Interrogation For Sequence Variants Gene Copy Number Amplifications Gene Rearrangements Microsatellite Instability And Tumor Mutation Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0433U | Oncology (Prostate) 5 Dna Regulatory Markers By Quantitative Pcr Whole Blood Algorithm Including Prostate-Specific Antigen Reported As Likelihood Of Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0434U | Drug Metabolism (Adverse Drug Reactions And Drug Response) Genomic Analysis Panel Variant Analysis Of 25 Genes With Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0437U | Psychiatry (Anxiety Disorders) Mrna Gene Expression Profiling By Rna Sequencing Of 15 Biomarkers Whole Blood Algorithm Reported As Predictive Risk Score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0438U | Drug Metabolism (Adverse Drug Reactions And Drug Response) Buccal Specimen Gene-Drug Interactions Variant Analysis Of 33 Genes Including Deletion/Duplication Analysis Of Cyp2D6 Including Reported Phenotypes And Impacted Genedrug Interactions | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0439U | Crd Chd Dna Alys 5 Snp 3 Dna | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0440U | Crd Chd Dna Alys 10 Snp 6Dna | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 139 Original policy |
| 0444U | Oncology (Solid Organ Neoplasia) Targeted Genomic Sequence Analysis Panel Of 361 Genes Interrogation For Gene Fusions Translocations Or Other Rearrangements Using Dna From Formalin-Fixed Paraffin-Embedded (Ffpe) Tumor Tissue Report Of Clinically Significant Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 140 Original policy |
| 0448U | Oncology (Lung And Colon Cancer) Dna Qualitative Nextgeneration Sequencing Detection Of Single- Nucleotide Variants And Deletions In Egfr And Kras Genes Formalin- Fixed Paraffinembedded (Ffpe) Solid Tumor Samples Reported As Presence Or Absence Of Targeted Mutation(S) With Recommended Therapeutic Options | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 140 Original policy |
| 0449U | Carrier Screening For Severe Inherited Conditions (Eg Cystic Fibrosis Spinal Muscular Atrophy Beta Hemoglobinopathies [Including Sickle Cell Disease] Alpha Thalassemia) Regardless Of Race Or Self-Identified Ancestry Genomic Sequence Analysis Panel Must Include Analysis Of 5 Genes (Cftr Smn1 Hbb Hba1 Hba2) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 140 Original policy |
| 0452U | Oncology (bladder), methylated PENK DNA detection by linear target enrichment-quantitative methylation- specific real-time PCR (LTE-qMSP), urine, reported as likelihood of bladder cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 140 Original policy |
| 0453U | Oncology (colorectal cancer), cellfree DNA (cfDNA), methylation- based quantitative PCR assay (SEPTIN9, IKZF1, BCAT1, Septin9- 2, VAV3, BCAN), plasma, reported as presence or absence of circulating tumor DNA (ctDNA) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 141 Original policy |
| 0454U | 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 141 Original policy |
| 0456U | Autoimmune (rheumatoid arthritis), next-generation sequencing (NGS), gene expression testing of 19 genes, whole blood, with analysis of anti- cyclic citrullinated peptides (CCP) levels, combined with sex, patient global assessment, and body mass index (BMI), algorithm reported as a score that predicts nonresponse to tumor necrosis factor inhibitor (TNFi) therapy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 141 Original policy |
| 0460U | Oncology, whole blood or buccal, DNA single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, with variant analysis and reported phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 141 Original policy |
| 0461U | Oncology, pharmacogenomic analysis of single-nucleotide polymorphism (SNP) genotyping by real-time PCR of 24 genes, whole blood or buccal swab, with variant analysis, including impacted gene- drug interactions and reported phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 141 Original policy |
| 0465U | Oncology (urothelial carcinoma), DNA, quantitative methylation- specific PCR of 2 genes (ONECUT2, VIM), algorithmic analysis reported as positive or negative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 142 Original policy |
| 0466U | Cardiology (coronary artery disease [CAD]), DNA, genome-wide association studies (564856 single- nucleotide polymorphisms [SNPs], targeted variant genotyping), patient lifestyle and clinical data, buccal swab, algorithm reported as polygenic risk to acquired heart disease | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 142 Original policy |
| 0467U | Oncology (bladder), DNA, next- generation sequencing (NGS) of 60 genes and whole genome aneuploidy, urine, algorithms reported as minimal residual disease (MRD) status positive or negative and quantitative disease burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 142 Original policy |
| 0469U | Rare diseases (constitutional/heritable disorders), whole genome sequence analysis for chromosomal abnormalities, copy number variants, duplications/deletions, inversions, unbalanced translocations, regions of homozygosity (ROH), inheritance pattern that indicate uniparental disomy (UPD), and aneuploidy, fetal sample (amniotic fluid, chorionic villus sample, or products of conception), identification and categorization of genetic variants, diagnostic report of fetal results based on phenotype with maternal sample and paternal sample, if performed, as comparators and/or maternal cell contamination | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 143 Original policy |
| 0471U | Oncology (colorectal cancer), qualitative real-time PCR of 35 variants of KRAS and NRAS genes (exons 2, 3, 4), formalin-fixed paraffin-embedded (FFPE), predictive, identification of detected mutations | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 143 Original policy |
| 0473U | Oncology (solid tumor), next- generation sequencing (NGS) of DNA from formalin-fixed paraffin- embedded (FFPE) tissue with comparative sequence analysis from a matched normal specimen (blood or saliva), 648 genes, interrogation for sequence variants, insertion and deletion alterations, copy number variants, rearrangements, microsatellite instability, and tumor- mutation burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 144 Original policy |
| 0474U | Hereditary pan-cancer (eg, hereditary sarcomas, hereditary endocrine tumors, hereditary neuroendocrine tumors, hereditary cutaneous melanoma), genomic sequence analysis panel of 88 genes with 20 duplications/deletions using next-generation sequencing (NGS), Sanger sequencing, blood or saliva, reported as positive or negative for germline variants, each gene | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 144 Original policy |
| 0475U | Hereditary prostate cancer-related disorders, genomic sequence analysis panel using next-generation sequencing (NGS), Sanger sequencing, multiplex ligation- dependent probe amplification (MLPA), and array comparative genomic hybridization (CGH), evaluation of 23 genes and duplications/deletions when indicated, pathologic mutations reported with a genetic risk score for prostate cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 144 Original policy |
| 0476U | Drug Metabolism, Psychiatry (Eg, Major Depressive Disorder, General Anxiety Disorder, Attention Deficit Hyperactivity Disorder [Adhd], Schizophrenia), Whole Blood, Buccal Swab, And Pharmacogenomic Genotyping Of 14 Genes And Cyp2D6 Copy Number Variant Analysis And Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 145 Original policy |
| 0477U | Drug Metabolism, Psychiatry (Eg, Major Depressive Disorder, General Anxiety Disorder, Attention Deficit Hyperactivity Disorder [Adhd], Schizophrenia), Whole Blood, Buccal Swab, And Pharmacogenomic Genotyping Of 14 Genes And Cyp2D6 Copy Number Variant Analysis, Including Impacted Gene-Drug Interactions And Reported Phenotypes | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 145 Original policy |
| 0478U | Oncology (Non-Small Cell Lung Cancer), Dna And Rna, Digital Pcr Analysis Of 9 Genes (Egfr, Kras, Braf, Alk, Ros1, Ret, Ntrk 1/2/3, Erbb2, And Met) In Formalin-Fixed Paraffin-Embedded (Ffpe) Tissue, Interrogation For Single-Nucleotide Variants, Insertions/Deletions, Gene Rearrangements, And Reported As Actionable Detected Variants For Therapy Selection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 145 Original policy |
| 0481U | Idh1 (Isocitrate Dehydrogenase 1 [Nadp+]), Idh2 (Isocitrate Dehydrogenase 2 [Nadp+]), And Tert (Telomerase Reverse Transcriptase) Promoter (Eg, Central Nervous System [Cns] Tumors), Next- Generation Sequencing (Single- Nucleotide Variants [Snv], Deletions, And Insertions) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 146 Original policy |
| 0485U | Oncology (Solid Tumor), Cell-Free Dna And Rna By Next-Generation Sequencing, Interpretative Report For Germline Mutations, Clonal Hematopoiesis Of Indeterminate Potential, And Tumor-Derived Single- Nucleotide Variants, Small Insertions/Deletions, Copy Number Alterations, Fusions, Microsatellite Instability, And Tumor Mutational Burden | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 146 Original policy |
| 0486U | Oncology (Pan-Solid Tumor), Next- Generation Sequencing Analysis Of Tumor Methylation Markers Present In Cell-Free Circulating Tumor Dna, Algorithm Reported As Quantitative Measurement Of Methylation As A Correlate Of Tumor Fraction | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 146 Original policy |
| 0487U | Oncology (Solid Tumor), Cell-Free Circulating Dna, Targeted Genomic Sequence Analysis Panel Of 84 Genes, Interrogation For Sequence Variants, Aneuploidy-Corrected Gene Copy Number Amplifications And Losses, Gene Rearrangements, And Microsatellite Instability | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 146 Original policy |
| 0488U | Obstetrics (Fetal Antigen Noninvasive Prenatal Test), Cell- Free Dna Sequence Analysis For Detection Of Fetal Presence Or Absence Of 1 Or More Of The Rh, C, C, D, E, Duffy (Fya), Or Kell (K) Antigen In Alloimmunized Pregnancies, Reported As Selected Antigen(S) Detected Or Not Detected | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 147 Original policy |
| 0489U | Obstetrics (Single-Gene Noninvasive Prenatal Test), Cell-Free Dna Sequence Analysis Of 1 Or More Targets (Eg, Cftr, Smn1, Hbb, Hba1, Hba2) To Identify Paternally Inherited Pathogenic Variants, And Relative Mutation-Dosage Analysis Based On Molecular Counts To Determine Fetal Inheritance Of Maternal Mutation, Algorithm Reported As A Fetal Risk Score For The Condition (Eg, Cystic Fibrosis, Spinal Muscular Atrophy, Beta Hemoglobinopathies [Including Sickle Cell Disease], Alpha Thalassemia) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 147 Original policy |
| 0493U | Transplantation Medicine, Quantification Of Donor-Derived Cell- Free Dna (Cfdna) Using Next- Generation Sequencing, Plasma, Reported As Percentage Of Donor- Derived Cell-Free Dna | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 147 Original policy |
| 0494U | Red Blood Cell Antigen (Fetal Rhd Gene Analysis), Next-Generation Sequencing Of Circulating Cell-Free Dna (Cfdna) Of Blood In Pregnant Individuals Known To Be Rhd Negative, Reported As Positive Or Negative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 148 Original policy |
| 0496U | Oncology (Colorectal), Cell-Free Dna, 8 Genes For Mutations, 7 Genes For Methylation By Real-Time Rt-Pcr, And 4 Proteins By Enzyme- Linked Immunosorbent Assay, Blood, Reported Positive Or Negative For Colorectal Cancer Or Advanced Adenoma Risk | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 148 Original policy |
| 0497U | Oncology (Prostate), Mrna Gene- Expression Profiling By Real-Time Rt- Pcr Of 6 Genes (Foxm1, Mcm3, Mtus1, Ttc21B, Alas1, And Ppp2Ca), Utilizing Formalin-Fixed Paraffin- Embedded (Ffpe) Tissue, Algorithm Reported As A Risk Score For Prostate Cancer | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 148 Original policy |
| 0498U | Oncology (Colorectal), Next- Generation Sequencing For Mutation Detection In 43 Genes And Methylation Pattern In 45 Genes, Blood, And Formalin-Fixed Paraffin- Embedded (Ffpe) Tissue, Report Of Variants And Methylation Pattern With Interpretation | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 148 Original policy |
| 0499U | Oncology (Colorectal And Lung), Dna From Formalin-Fixed Paraffin- Embedded (Ffpe) Tissue, Next- Generation Sequencing Of 8 Genes (Nras, Egfr, Ctnnb1, Pik3Ca, Apc, Braf, Kras, And Tp53), Mutation Detection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 148 Original policy |
| 0500U | Autoinflammatory Disease (Vexas Syndrome), Dna, Uba1 Gene Mutations, Targeted Variant Analysis (M41T, M41V, M41L, C.118-2A>C, C.118-1G>C, C.118- 9_118-2Del, S56F, S621C) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 149 Original policy |