Blue Cross Blue Shield Oklahoma prior authorization, page 24
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 |
|---|---|---|
| E0748 | Osteogenesis Stimulator Electrical Non-Invasive Spinal Applications | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy |
| E0749 | Osteogenesis Stimulator Electrical Surgically Implanted | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy |
| G0289 | Arthroscopy Knee Surgical For Removal Of Loose Body Foreign Body Debridement/Shaving Of Articular Cartilage (Chrondroplasty) At The Time Of Other Surgical Knee Arthroscopy In A Different Compartment Of The Same Knee | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 192 Original policy |
| J7330 | Autologous Cultured Chondrocytes Implant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| S2112 | Arthroscopy Knee Surgical For Harvesting Of Cartilage (Chondrocyte Cells) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 27096 | Injection Procedure For Sacroiliac Joint Anesthetic/Steroid With Image Guidance (Fluoroscopy Or Ct) Including Arthrography When Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 62280 | Injection/Infusion Of Neurolytic Substance (Eg Alcohol Phenol Iced Saline Solutions) With Or Without Other Therapeutic Substance; Subarachnoid | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 62281 | Injection/Infusion Of Neurolytic Substance (Eg Alcohol Phenol Iced Saline Solutions) With Or Without Other Therapeutic Substance; Epidural Cervical Or Thoracic | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 62282 | Injection/Infusion Of Neurolytic Substance (Eg Alcohol Phenol Iced Saline Solutions) With Or Without Other Therapeutic Substance; Epidural Lumbar Sacral (Caudal) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 62292 | Injection Procedure For Chemonucleolysis Including Discography Intervertebral Disc Single Or Multiple Levels Lumbar | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 193 Original policy |
| 62320 | Injection(S) Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Including Needle Or Catheter Placement Interlaminar Epidural Or Subarachnoid Cervical Or Thoracic; Without Imaging Guidance | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 194 Original policy |
| 62321 | Injection(S) Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Including Needle Or Catheter Placement Interlaminar Epidural Or Subarachnoid Cervical Or Thoracic; With Imaging Guidance (Ie Fluoroscopy Or Ct) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 194 Original policy |
| 62322 | Injection(S) Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Including Needle Or Catheter Placement Interlaminar Epidural Or Subarachnoid Lumbar Or Sacral (Caudal); Without Imaging Guidance | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 194 Original policy |
| 62323 | Injection(S) Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Including Needle Or Catheter Placement Interlaminar Epidural Or Subarachnoid Lumbar Or Sacral (Caudal); With Imaging Guidance (Ie Fluoroscopy Or Ct) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 194 Original policy |
| 62325 | Injection(S) Including Indwelling Catheter Placement Continuous Infusion Or Intermittent Bolus Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Interlaminar Epidural Or Subarachnoid Cervical Or Thoracic; With Imaging Guidance (Ie Fluoroscopy Or Ct) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 195 Original policy |
| 62327 | Injection(S) Including Indwelling Catheter Placement Continuous Infusion Or Intermittent Bolus Of Diagnostic Or Therapeutic Substance(S) (Eg Anesthetic Antispasmodic Opioid Steroid Other Solution) Not Including Neurolytic Substances Interlaminar Epidural Or Subarachnoid Lumbar Or Sacral (Caudal); With Imaging Guidance (Ie Fluoroscopy Or Ct) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 195 Original policy |
| 62350 | Implantation Revision Or Repositioning Of Tunneled Intrathecal Or Epidural Catheter For Long-Term Medication Administration Via An External Pump Or Implantable Reservoir/Infusion Pump; Without Laminectomy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 195 Original policy |
| 62351 | Implantation Revision Or Repositioning Of Tunneled Intrathecal Or Epidural Catheter For Long-Term Medication Administration Via An External Pump Or Implantable Reservoir/Infusion Pump; With Laminectomy | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 195 Original policy |
| 62360 | Implantation Or Replacement Of Device For Intrathecal Or Epidural Drug Infusion; Subcutaneous Reservoir | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 62361 | Implantation Or Replacement Of Device For Intrathecal Or Epidural Drug Infusion; Nonprogrammable Pump | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 62362 | Implantation Or Replacement Of Device For Intrathecal Or Epidural Drug Infusion; Programmable Pump Including Preparation Of Pump With Or Without Programming | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63650 | Percutaneous Implantation Of Neurostimulator Electrode Array Epidural | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63655 | Laminectomy For Implantation Of Neurostimulator Electrodes Plate/Paddle Epidural | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63663 | Revision Including Replacement When Performed Of Spinal Neurostimulator Electrode Percutaneous Array(S) Including Fluoroscopy When Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63664 | Revision Including Replacement When Performed Of Spinal Neurostimulator Electrode Plate/Paddle(S) Placed Via Laminotomy Or Laminectomy Including Fluoroscopy When Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63685 | Insertion Or Replacement Of Spinal Neurostimulator Pulse Generator Or Receiver Requiring Pocket Creation And Connection Between Electrode Array And Pulse Generator Or Receiver | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 196 Original policy |
| 63688 | Revision Or Removal Of Implanted Spinal Neurostimulator Pulse Generator Or Receiver With Detachable Connection To Electrode Array | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64451 | Injection(S) Anesthetic Agent(S) And/Or Steroid; Nerves Innervating The Sacroiliac Joint With Image Guidance (Ie Fluoroscopy Or Computed Tomography) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64479 | Injection(S) Anesthetic Agent(S) And/Or Steroid; Transforaminal Epidural With Imaging Guidance (Fluoroscopy Or Ct) Cervical Or Thoracic Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64480 | Injection(S) Anesthetic Agent(S) And/Or Steroid; Transforaminal Epidural With Imaging Guidance (Fluoroscopy Or Ct) Cervical Or Thoracic Each Additional Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64483 | Injection(S) Anesthetic Agent(S) And/Or Steroid; Transforaminal Epidural With Imaging Guidance (Fluoroscopy Or Ct) Lumbar Or Sacral Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64484 | Injection(S) Anesthetic Agent(S) And/Or Steroid; Transforaminal Epidural With Imaging Guidance (Fluoroscopy Or Ct) Lumbar Or Sacral Each Additional Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 197 Original policy |
| 64490 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Cervical Or Thoracic; Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 198 Original policy |
| 64491 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Cervical Or Thoracic; Second Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 198 Original policy |
| 64492 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Cervical Or Thoracic; Third And Any Additional Level(S) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 198 Original policy |
| 64493 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Lumbar Or Sacral; Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 198 Original policy |
| 64494 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Lumbar Or Sacral; Second Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64495 | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Image Guidance (Fluoroscopy Or Ct) Lumbar Or Sacral; Third And Any Additional Level(S) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64510 | Injection Anesthetic Agent; Stellate Ganglion (Cervical Sympathetic) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64520 | Injection Anesthetic Agent; Lumbar Or Thoracic (Paravertebral Sympathetic) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64625 | Radiofrequency Ablation Nerves Innervating The Sacroiliac Joint With Image Guidance (Ie Fluoroscopy Or Computed Tomography) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64633 | Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Cervical Or Thoracic Single Facet Joint | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 199 Original policy |
| 64634 | Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Cervical Or Thoracic Each Additional Facet Joint (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 200 Original policy |
| 64635 | Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral Single Facet Joint | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 200 Original policy |
| 64636 | Destruction By Neurolytic Agent Paravertebral Facet Joint Nerve(S) With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral Each Additional Facet Joint (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 200 Original policy |
| 0213T | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance Cervical Or Thoracic; Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 200 Original policy |
| 0214T | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance Cervical Or Thoracic; Second Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 200 Original policy |
| 0215T | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance Cervical Or Thoracic; Third And Any Additional Level(S) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 201 Original policy |
| 0216T | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance Lumbar Or Sacral; Single Level | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 201 Original policy |
| 0217T | Injection(S) Diagnostic Or Therapeutic Agent Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance Lumbar Or Sacral; Second Level (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 201 Original policy |