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Blue Cross Blue Shield Oklahoma prior authorization, page 23

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
63053Laminectomy 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; Each Additional 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
63055Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Thoracic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 185 Original policy
63056Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Lumbar (Including Transfacet Or Lateral Extraforaminal Approach) (Eg Far Lateral Herniated Intervertebral Disc)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 185 Original policy
63057Transpedicular Approach With Decompression Of Spinal Cord Equina And/Or Nerve Root(S) (Eg Herniated Intervertebral Disc) Single Segment; Each Additional Segment Thoracic Or Lumbar (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 186 Original policy
63075Discectomy Anterior With Decompression Of Spinal Cord And/Or Nerve Root(S) Including Osteophytectomy; Cervical Single Interspace2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 186 Original policy
63076Discectomy Anterior With Decompression Of Spinal Cord And/Or Nerve Root(S) Including Osteophytectomy; Cervical Each Additional Interspace (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 186 Original policy
63081Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Anterior Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Cervical Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 186 Original policy
63082Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Anterior Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Cervical Each Additional Segment (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 186 Original policy
63085Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 187 Original policy
63086Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transthoracic Approach With Decompression Of Spinal Cord And/Or Nerve Root(S); Thoracic Each Additional Segment (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 187 Original policy
63087Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Combined Thoracolumbar Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Or Lumbar; Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 187 Original policy
63088Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Combined Thoracolumbar Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Or Lumbar; Each Additional Segment (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 187 Original policy
63090Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transperitoneal Or Retroperitoneal Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar Or Sacral; Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 187 Original policy
63091Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Transperitoneal Or Retroperitoneal Approach With Decompression Of Spinal Cord Cauda Equina Or Nerve Root(S) Lower Thoracic Lumbar Or Sacral; Each Additional Segment (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63101Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Thoracic Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63102Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Lumbar Single Segment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63103Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete Lateral Extracavitary Approach With Decompression Of Spinal Cord And/Or Nerve Root(S) (Eg For Tumor Or Retropulsed Bone Fragments); Thoracic Or Lumbar Each Additional Segment (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63185Laminectomy With Rhizotomy; 1 Or 2 Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63190Laminectomy With Rhizotomy; More Than 2 Segments2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 188 Original policy
63191Laminectomy With Section Of Spinal Accessory Nerve2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63200Laminectomy With Release Of Tethered Spinal Cord Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63250Laminectomy For Excision Or Occlusion Of Arteriovenous Malformation Of Spinal Cord; Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63252Laminectomy For Excision Or Occlusion Of Arteriovenous Malformation Of Spinal Cord; Thoracolumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63265Laminectomy For Excision Or Evacuation Of Intraspinal Lesion Other Than Neoplasm Extradural; Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63267Laminectomy For Excision Or Evacuation Of Intraspinal Lesion Other Than Neoplasm Extradural; Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63270Laminectomy For Excision Of Intraspinal Lesion Other Than Neoplasm Intradural; Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63272Laminectomy For Excision Of Intraspinal Lesion Other Than Neoplasm Intradural; Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63275Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Extradural Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63277Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Extradural Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63280Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Extramedullary Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63282Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Extramedullary Lumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 189 Original policy
63285Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Intramedullary Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63287Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Intradural Intramedullary Thoracolumbar2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63290Laminectomy For Biopsy/Excision Of Intraspinal Neoplasm; Combined Extradural-Intradural Lesion Any Level2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63300Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Extradural Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63301Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Extradural Thoracic By Transthoracic Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63302Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Extradural Thoracic By Thoracolumbar Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63303Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Extradural Lumbar Or Sacral By Transperitoneal Or Retroperitoneal Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63304Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Intradural Cervical2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 190 Original policy
63305Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Intradural Thoracic By Transthoracic Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
63306Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Intradural Thoracic By Thoracolumbar Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
63307Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Intradural Lumbar Or Sacral By Transperitoneal Or Retroperitoneal Approach2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
63308Vertebral Corpectomy (Vertebral Body Resection) Partial Or Complete For Excision Of Intraspinal Lesion Single Segment; Each Additional Segment (List Separately In Addition To Codes For Single Segment)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
0095TRemoval Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Each Additional Interspace Cervical (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
0098TRevision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Each Additional Interspace Cervical (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 191 Original policy
0164TRemoval Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Each Additional Interspace Lumbar (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy
0165TRevision Including Replacement Of Total Disc Arthroplasty (Artificial Disc) Anterior Approach Each Additional Interspace Lumbar (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy
0707TInjection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy
C9359Porous Purified Collagen Matrix Bone Void Filler (Integra Mozaik Osteoconductive Scaffold Putty Integra Os Osteoconductive Scaffold Putty) Per 0.5 Cc2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy
C9362Porous Purified Collagen Matrix Bone Void Filler (Integra Mozaik Osteoconductive Scaffold Strip) Per 0.5 Cc2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy

Sources

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