Blue Cross Blue Shield Oklahoma prior authorization, page 19
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 |
|---|---|---|
| 20932 | Allograft Includes Templating Cutting Placement And Internal Fixation When Performed; Osteoarticular Including Articular Surface And Contiguous Bone (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 159 Original policy |
| 20933 | Allograft Includes Templating Cutting Placement And Internal Fixation When Performed; Hemicortical Intercalary Partial (Ie Hemicylindrical) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 159 Original policy |
| 20934 | Allograft Includes Templating Cutting Placement And Internal Fixation When Performed; Intercalary Complete (Ie Cylindrical) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20936 | Autograft For Spine Surgery Only (Includes Harvesting The Graft); Local (Eg Ribs Spinous Process Or Laminar Fragments) Obtained From Same Incision (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20937 | Autograft For Spine Surgery Only (Includes Harvesting The Graft); Morselized (Through Separate Skin Or Fascial Incision) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20938 | Autograft For Spine Surgery Only (Includes Harvesting The Graft); Structural Bicortical Or Tricortical (Through Separate Skin Or Fascial Incision) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20939 | Bone Marrow Aspiration For Bone Grafting Spine Surgery Only Through Separate Skin Or Fascial Incision (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20974 | Electrical Stimulation To Aid Bone Healing; Noninvasive (Nonoperative) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 20975 | Electrical Stimulation To Aid Bone Healing; Invasive (Operative) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 160 Original policy |
| 22206 | Osteotomy Of Spine Posterior Or Posterolateral Approach 3 Columns 1 Vertebral Segment (Eg Pedicle/Vertebral Body Subtraction); Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22207 | Osteotomy Of Spine Posterior Or Posterolateral Approach 3 Columns 1 Vertebral Segment (Eg Pedicle/Vertebral Body Subtraction); Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22208 | Osteotomy Of Spine Posterior Or Posterolateral Approach 3 Columns 1 Vertebral Segment (Eg Pedicle/Vertebral Body Subtraction); Each Additional Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22210 | Osteotomy Of Spine Posterior Or Posterolateral Approach 1 Vertebral Segment; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22212 | Osteotomy Of Spine Posterior Or Posterolateral Approach 1 Vertebral Segment; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22214 | Osteotomy Of Spine Posterior Or Posterolateral Approach 1 Vertebral Segment; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22216 | Osteotomy Of Spine Posterior Or Posterolateral Approach 1 Vertebral Segment; Each Additional Vertebral Segment (List Separately In Addition To Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22220 | Osteotomy Of Spine Including Discectomy Anterior Approach Single Vertebral Segment; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22222 | Osteotomy Of Spine Including Discectomy Anterior Approach Single Vertebral Segment; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 161 Original policy |
| 22224 | Osteotomy Of Spine Including Discectomy Anterior Approach Single Vertebral Segment; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22226 | Osteotomy Of Spine Including Discectomy Anterior Approach Single Vertebral Segment; Each Additional Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22510 | Percutaneous Vertebroplasty (Bone Biopsy Included When Performed) 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance; Cervicothoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22511 | Percutaneous Vertebroplasty (Bone Biopsy Included When Performed) 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance; Lumbosacral | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22512 | Percutaneous Vertebroplasty (Bone Biopsy Included When Performed) 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance; Each Additional Cervicothoracic Or Lumbosacral Vertebral Body (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22513 | Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 162 Original policy |
| 22514 | Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 163 Original policy |
| 22515 | Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Each Additional Thoracic Or Lumbar Vertebral Body (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 163 Original policy |
| 22532 | Arthrodesis Lateral Extracavitary Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 163 Original policy |
| 22533 | Arthrodesis Lateral Extracavitary Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 163 Original policy |
| 22534 | Arthrodesis Lateral Extracavitary Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Thoracic Or Lumbar Each Additional Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 163 Original policy |
| 22548 | Arthrodesis Anterior Transoral Or Extraoral Technique Clivus-C1-C2 (Atlas-Axis) With Or Without Excision Of Odontoid Process | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22551 | Arthrodesis Anterior Interbody Including Disc Space Preparation Discectomy Osteophytectomy And Decompression Of Spinal Cord And/Or Nerve Roots; Cervical Below C2 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22552 | Arthrodesis Anterior Interbody Including Disc Space Preparation Discectomy Osteophytectomy And Decompression Of Spinal Cord And/Or Nerve Roots; Cervical Below C2 Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22554 | Arthrodesis Anterior Interbody Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Cervical Below C2 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22556 | Arthrodesis Anterior Interbody Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22558 | Arthrodesis Anterior Interbody Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 164 Original policy |
| 22585 | Arthrodesis Anterior Interbody Technique Including Minimal Discectomy To Prepare Interspace (Other Than For Decompression); Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22590 | Arthrodesis Posterior Technique Craniocervical (Occiput-C2) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22595 | Arthrodesis Posterior Technique Atlas-Axis (C1-C2) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22600 | Arthrodesis Posterior Or Posterolateral Technique Single Interspace; Cervical Below C2 Segment | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22610 | Arthrodesis Posterior Or Posterolateral Technique Single Interspace; Thoracic (With Lateral Transverse Technique When Performed) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22612 | Arthrodesis Posterior Or Posterolateral Technique Single Interspace; Lumbar (With Lateral Transverse Technique When Performed) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22614 | Arthrodesis Posterior Or Posterolateral Technique Single Interspace; Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22630 | Arthrodesis Posterior Interbody Technique Including Laminectomy And/Or Discectomy To Prepare Interspace (Other Than For Decompression) Single Interspace Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 165 Original policy |
| 22632 | Arthrodesis Posterior Interbody Technique Including Laminectomy And/Or Discectomy To Prepare Interspace (Other Than For Decompression) Single Interspace Lumbar; Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22633 | Arthrodesis Combined Posterior Or Posterolateral Technique With Posterior Interbody Technique Including Laminectomy And/Or Discectomy Sufficient To Prepare Interspace (Other Than For Decompression) Single Interspace Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22634 | Arthrodesis Combined Posterior Or Posterolateral Technique With Posterior Interbody Technique Including Laminectomy And/Or Discectomy Sufficient To Prepare Interspace (Other Than For Decompression) Single Interspace Lumbar; Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22800 | Arthrodesis Posterior For Spinal Deformity With Or Without Cast; Up To 6 Vertebral Segments | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22802 | Arthrodesis Posterior For Spinal Deformity With Or Without Cast; 7 To 12 Vertebral Segments | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22804 | Arthrodesis Posterior For Spinal Deformity With Or Without Cast; 13 Or More Vertebral Segments | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 166 Original policy |
| 22808 | Arthrodesis Anterior For Spinal Deformity With Or Without Cast; 2 To 3 Vertebral Segments | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy |