Blue Cross Blue Shield Oklahoma prior authorization, page 22
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 |
|---|---|---|
| 29861 | Arthroscopy Hip Surgical; With Removal Of Loose Body Or Foreign Body | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 177 Original policy |
| 29862 | Arthroscopy Hip Surgical; With Debridement/Shaving Of Articular Cartilage (Chondroplasty) Abrasion Arthroplasty And/Or Resection Of Labrum | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 177 Original policy |
| 29863 | Arthroscopy Hip Surgical; With Synovectomy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 177 Original policy |
| 29866 | Arthroscopy Knee Surgical; Osteochondral Autograft(S) (Eg Mosaicplasty) (Includes Harvesting Of The Autograft[S]) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 177 Original policy |
| 29867 | Arthroscopy Knee Surgical; Osteochondral Allograft (Eg Mosaicplasty) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 177 Original policy |
| 29868 | Arthroscopy Knee Surgical; Meniscal Transplantation (Includes Arthrotomy For Meniscal Insertion) Medial Or Lateral | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29870 | Arthroscopy Knee Diagnostic With Or Without Synovial Biopsy (Separate Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29871 | Arthroscopy Knee Surgical; For Infection Lavage And Drainage | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29873 | Arthroscopy Knee Surgical; With Lateral Release | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29874 | Arthroscopy Knee Surgical; For Removal Of Loose Body Or Foreign Body (Eg Osteochondritis Dissecans Fragmentation Chondral Fragmentation) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29875 | Arthroscopy Knee Surgical; Synovectomy Limited (Eg Plica Or Shelf Resection) (Separate Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29876 | Arthroscopy Knee Surgical; Synovectomy Major 2 Or More Compartments (Eg Medial Or Lateral) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29877 | Arthroscopy Knee Surgical; Debridement/Shaving Of Articular Cartilage (Chondroplasty) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29879 | Arthroscopy Knee Surgical; Abrasion Arthroplasty (Includes Chondroplasty Where Necessary) Or Multiple Drilling Or Microfracture | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 178 Original policy |
| 29880 | Arthroscopy Knee Surgical; With Meniscectomy (Medial And Lateral Including Any Meniscal Shaving) Including Debridement/Shaving Of Articular Cartilage (Chondroplasty) Same Or Separate Compartment(S) When Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29881 | Arthroscopy Knee Surgical; With Meniscectomy (Medial Or Lateral Including Any Meniscal Shaving) Including Debridement/Shaving Of Articular Cartilage (Chondroplasty) Same Or Separate Compartment(S) When Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29882 | Arthroscopy Knee Surgical; With Meniscus Repair (Medial Or Lateral) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29883 | Arthroscopy Knee Surgical; With Meniscus Repair (Medial And Lateral) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29884 | Arthroscopy Knee Surgical; With Lysis Of Adhesions With Or Without Manipulation (Separate Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29885 | Arthroscopy Knee Surgical; Drilling For Osteochondritis Dissecans With Bone Grafting With Or Without Internal Fixation (Including Debridement Of Base Of Lesion) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29886 | Arthroscopy Knee Surgical; Drilling For Intact Osteochondritis Dissecans Lesion | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29887 | Arthroscopy Knee Surgical; Drilling For Intact Osteochondritis Dissecans Lesion With Internal Fixation | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 179 Original policy |
| 29888 | Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation Or Reconstruction | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 29889 | Arthroscopically Aided Posterior Cruciate Ligament Repair/Augmentation Or Reconstruction | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 29892 | Arthroscopically Aided Repair Of Large Osteochondritis Dissecans Lesion Talar Dome Fracture Or Tibial Plafond Fracture With Or Without Internal Fixation (Includes Arthroscopy) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 29914 | Arthroscopy Hip Surgical; With Femoroplasty (Ie Treatment Of Cam Lesion) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 29915 | Arthroscopy Hip Surgical; With Acetabuloplasty (Ie Treatment Of Pincer Lesion) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 29916 | Arthroscopy Hip Surgical; With Labral Repair | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 62380 | Endoscopic Decompression Of Spinal Cord Nerve Root(S) Including Laminotomy Partial Facetectomy Foraminotomy Discectomy And/Or Excision Of Herniated Intervertebral Disc 1 Interspace Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 63001 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) 1 Or 2 Vertebral Segments; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 180 Original policy |
| 63003 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) 1 Or 2 Vertebral Segments; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 181 Original policy |
| 63005 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) 1 Or 2 Vertebral Segments; Lumbar Except For Spondylolisthesis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 181 Original policy |
| 63012 | Laminectomy With Removal Of Abnormal Facets And/Or Pars Inter- Articularis With Decompression Of Cauda Equina And Nerve Roots For Spondylolisthesis Lumbar (Gill Type Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 181 Original policy |
| 63015 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 181 Original policy |
| 63016 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 181 Original policy |
| 63017 | Laminectomy With Exploration And/Or Decompression Of Spinal Cord And/Or Cauda Equina Without Facetectomy Foraminotomy Or Discectomy (Eg Spinal Stenosis) More Than 2 Vertebral Segments; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 182 Original policy |
| 63020 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; 1 Interspace Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 182 Original policy |
| 63030 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; 1 Interspace Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 182 Original policy |
| 63035 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc; Each Additional Interspace Cervical Or Lumbar (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 182 Original policy |
| 63040 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 182 Original policy |
| 63042 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 183 Original policy |
| 63043 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Each Additional Cervical Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 183 Original policy |
| 63044 | Laminotomy (Hemilaminectomy) With Decompression Of Nerve Root(S) Including Partial Facetectomy Foraminotomy And/Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace; Each Additional Lumbar Interspace (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 183 Original policy |
| 63045 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Cervical | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 183 Original policy |
| 63046 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 184 Original policy |
| 63047 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 184 Original policy |
| 63048 | Laminectomy Facetectomy And Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) Single Vertebral Segment; Each Additional Vertebral Segment Cervical Thoracic Or Lumbar (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 184 Original policy |
| 63050 | Laminoplasty Cervical With Decompression Of The Spinal Cord 2 Or More Vertebral Segments | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 184 Original policy |
| 63051 | Laminoplasty Cervical With Decompression Of The Spinal Cord 2 Or More Vertebral Segments; With Reconstruction Of The Posterior Bony Elements (Including The Application Of Bridging Bone Graft And Non-Segmental Fixation Devices [Eg Wire Suture Mini- Plates] When Performed) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 184 Original policy |
| 63052 | Laminectomy Facetectomy Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord Cauda Equina And/Or Nerve Root[S] [Eg Spinal Or Lateral Recess Stenosis]) During Posterior Interbody Arthrodesis Lumbar; Single Vertebral Segment (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 185 Original policy |