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Blue Cross Blue Shield Oklahoma prior authorization, page 20

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

Prior authorization codes
CodeDescriptionSource
22810Arthrodesis Anterior For Spinal Deformity With Or Without Cast; 4 To 7 Vertebral Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22812Arthrodesis Anterior For Spinal Deformity With Or Without Cast; 8 Or More Vertebral Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22818Kyphectomy Circumferential Exposure Of Spine And Resection Of Vertebral Segment(S) (Including Body And Posterior Elements); Single Or 2 Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22819Kyphectomy Circumferential Exposure Of Spine And Resection Of Vertebral Segment(S) (Including Body And Posterior Elements); 3 Or More Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22830Exploration Of Spinal Fusion2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22840Posterior Non-Segmental Instrumentation (Eg Harrington Rod Technique Pedicle Fixation Across 1 Interspace Atlantoaxial Transarticular Screw Fixation Sublaminar Wiring At C1 Facet Screw Fixation) (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22841Internal Spinal Fixation By Wiring Of Spinous Processes (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 167 Original policy
22842Posterior Segmental Instrumentation (Eg Pedicle Fixation Dual Rods With Multiple Hooks And Sublaminar Wires); 3 To 6 Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22843Posterior Segmental Instrumentation (Eg Pedicle Fixation Dual Rods With Multiple Hooks And Sublaminar Wires); 7 To 12 Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22844Posterior Segmental Instrumentation (Eg Pedicle Fixation Dual Rods With Multiple Hooks And Sublaminar Wires); 13 Or More Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22845Anterior Instrumentation; 2 To 3 Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22846Anterior Instrumentation; 4 To 7 Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22847Anterior Instrumentation; 8 Or More Vertebral Segments (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22848Pelvic Fixation (Attachment Of Caudal End Of Instrumentation To Pelvic Bony Structures) Other Than Sacrum (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22849Reinsertion Of Spinal Fixation Device2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 168 Original policy
22853Insertion Of Interbody Biomechanical Device(S) (Eg Synthetic Cage Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg Screws Flanges) When Performed To Intervertebral Disc Space In Conjunction With Interbody Arthrodesis Each Interspace (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 169 Original policy
22854Insertion Of Intervertebral Biomechanical Device(S) (Eg Synthetic Cage Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg Screws Flanges) When Performed To Vertebral Corpectomy(Ies) (Vertebral Body Resection Partial Or Complete) Defect In Conjunction With Interbody Arthrodesis Each Contiguous Defect (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 169 Original policy
22856Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy With End Plate Preparation (Includes Osteophytectomy For Nerve Root Or Spinal Cord Decompression And Microdissection); Single Interspace Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 169 Original policy
22857Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Single Interspace Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 169 Original policy
22858Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy With End Plate Preparation (Includes Osteophytectomy For Nerve Root Or Spinal Cord Decompression And Microdissection); Second Level Cervical (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 170 Original policy
22859Insertion Of Intervertebral Biomechanical Device(S) (Eg Synthetic Cage Mesh Methylmethacrylate) To Intervertebral Disc Space Or Vertebral Body Defect Without Interbody Arthrodesis Each Contiguous Defect (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 170 Original policy
22860Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy To Prepare Interspace (Other Than For Decompression); Second Interspace Lumbar (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 170 Original policy
22861Revision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 170 Original policy
22862Revision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 170 Original policy
22864Removal Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
22865Removal Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Single Interspace; Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23105Arthrotomy; Glenohumeral Joint With Synovectomy With Or Without Biopsy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23107Arthrotomy Glenohumeral Joint With Joint Exploration With Or Without Removal Of Loose Or Foreign Body2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23120Claviculectomy; Partial2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23410Repair Of Ruptured Musculotendinous Cuff (Eg Rotator Cuff) Open; Acute2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23412Repair Of Ruptured Musculotendinous Cuff (Eg Rotator Cuff) Open; Chronic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23415Coracoacromial Ligament Release With Or Without Acromioplasty2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23420Reconstruction Of Complete Shoulder (Rotator) Cuff Avulsion Chronic (Includes Acromioplasty)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23430Tenodesis Of Long Tendon Of Biceps2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23440Resection Or Transplantation Of Long Tendon Of Biceps2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23450Capsulorrhaphy Anterior; Putti-Platt Procedure Or Magnuson Type Operation2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23455Capsulorrhaphy Anterior; With Labral Repair (Eg Bankart Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23460Capsulorrhaphy Anterior Any Type; With Bone Block2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 171 Original policy
23462Capsulorrhaphy Anterior Any Type; With Coracoid Process Transfer2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23465Capsulorrhaphy Glenohumeral Joint Posterior With Or Without Bone Block2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23466Capsulorrhaphy Glenohumeral Joint Any Type Multidirectional Instability2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23470Arthroplasty Glenohumeral Joint; Hemiarthroplasty2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23472Arthroplasty Glenohumeral Joint; Total Shoulder (Glenoid And Proximal Humeral Replacement (Eg Total Shoulder))2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23473Revision Of Total Shoulder Arthroplasty Including Allograft When Performed; Humeral Or Glenoid Component2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23474Revision Of Total Shoulder Arthroplasty Including Allograft When Performed; Humeral And Glenoid Component2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
23700Manipulation Under Anesthesia Shoulder Joint Including Application Of Fixation Apparatus (Dislocation Excluded)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
27120Acetabuloplasty; (Eg Whitman Colonna Haygroves Or Cup Type)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
27122Acetabuloplasty; Resection Femoral Head (Eg Girdlestone Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
27125Hemiarthroplasty Hip Partial (Eg Femoral Stem Prosthesis Bipolar Arthroplasty)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 172 Original policy
27130Arthroplasty Acetabular And Proximal Femoral Prosthetic Replacement (Total Hip Arthroplasty) With Or Without Autograft Or Allograft2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 173 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

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