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Blue Cross Blue Shield Oklahoma prior authorization, page 28

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
G6012Radiation Treatment Delivery 3 Or More Separate Treatment Areas Custom Blocking Tangential Ports Wedges Rotational Beam Compensators Electron Beam; 6- 10Mev2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
G6013Radiation Treatment Delivery 3 Or More Separate Treatment Areas Custom Blocking Tangential Ports Wedges Rotational Beam Compensators Electron Beam; 11- 19Mev2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
G6014Radiation Treatment Delivery 3 Or More Separate Treatment Areas Custom Blocking Tangential Ports Wedges Rotational Beam Compensators Electron Beam; 20Mev Or Greater2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
G6015Intensity Modulated Treatment Delivery Single Or Multiple Fields/Arcs Via Narrow Spatially And Temporally Modulated Beams Binary Dynamic Mlc Per Treatment Session2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
G6016Compensator-Based Beam Modulation Treatment Delivery Of Inverse Planned Treatment Using 3 Or More High Resolution (Milled Or Cast) Compensator Convergent Beam Modulated Fields Per Treatment Session2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
G6017Intra-Fraction Localization And Tracking Of Target Or Patient Motion During Delivery Of Radiation Therapy (Eg 3D Positional Tracking Gating 3D Surface Tracking) Each Fraction Of Treatment2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
Q3001Radioelements For Brachytherapy Any Type Each2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 218 Original policy
S8030Scleral Application Of Tantalum Ring(S) For Localization Of Lesions For Proton Beam Therapy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
32851Lung Transplant Single; Without Cardiopulmonary Bypass2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
32852Lung Transplant Single; With Cardiopulmonary Bypass2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
32853Lung Transplant Double (Bilateral Sequential Or En Bloc); Without Cardiopulmonary Bypass2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
32854Lung Transplant Double (Bilateral Sequential Or En Bloc); With Cardiopulmonary Bypass2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
33935Heart-Lung Transplant With Recipient Cardiectomy- Pneumonectomy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
33945Heart Transplant With Or Without Recipient Cardiectomy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38204Management Of Recipient Hematopoietic Progenitor Cell Donor Search And Cell Acquisition2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38205Blood-Derived Hematopoietic Progenitor Cell Harvesting For Transplantation Per Collection; Allogeneic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38206Blood-Derived Hematopoietic Progenitor Cell Harvesting For Transplantation Per Collection; Autologous2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38207Transplant Preparation Of Hematopoietic Progenitor Cells; Cryopreservation And Storage2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38230Bone Marrow Harvesting For Transplantation; Allogeneic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38232Bone Marrow Harvesting For Transplantation; Autologous2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38240Hematopoietic Progenitor Cell (Hpc); Allogeneic Transplantation Per Donor2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 219 Original policy
38241Hematopoietic Progenitor Cell (Hpc); Autologous Transplantation2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
38242Allogeneic Lymphocyte Infusions2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
38243Hematopoietic Progenitor Cell (Hpc); Hpc Boost2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
44135Intestinal Allotransplantation; From Cadaver Donor2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
44136Intestinal Allotransplantation; From Living Donor2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
47135Liver Allotransplantation Orthotopic Partial Or Whole From Cadaver Or Living Donor Any Age2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
48160Pancreatectomy Total Or Subtotal With Autologous Transplantation Of Pancreas Or Pancreatic Islet Cells2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
48554Transplantation Of Pancreatic Allograft2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
50360Renal Allotransplantation Implantation Of Graft; Without Recipient Nephrectomy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
50365Renal Allotransplantation Implantation Of Graft; With Recipient Nephrectomy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
50380Reimplantation Of Kidney2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
0584TIslet Cell Transplant Includes Portal Vein Catheterization And Infusion Including All Imaging Including Guidance And Radiological Supervision And Interpretation When Performed; Percutaneous2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
0585TIslet Cell Transplant Includes Portal Vein Catheterization And Infusion Including All Imaging Including Guidance And Radiological Supervision And Interpretation When Performed; Laparoscopic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 220 Original policy
0586TIslet Cell Transplant Includes Portal Vein Catheterization And Infusion Including All Imaging Including Guidance And Radiological Supervision And Interpretation When Performed; Open2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
G0341Percutaneous Islet Cell Transplant Includes Portal Vein Catheterization And Infusion2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
G0342Laparoscopy For Islet Cell Transplant Includes Portal Vein Catheterization And Infusion2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
G0343Laparotomy For Islet Cell Transplant Includes Portal Vein Catheterization And Infusion2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2053Transplantation Of Small Intestine And Liver Allografts2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2054Transplantation Of Multivisceral Organs2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2060Lobar Lung Transplantation2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2065Simultaneous Pancreas Kidney Transplantation2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2102Islet Cell Tissue Transplant From Pancreas; Allogeneic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2140Cord Blood Harvesting For Transplantation Allogeneic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2142Cord Blood-Derived Stem-Cell Transplantation Allogeneic2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 221 Original policy
S2150Bone Marrow Or Blood-Derived Stem Cells (Peripheral Or Umbilical) Allogeneic Or Autologous Harvesting Transplantation And Related Complications; Including: Pheresis And Cell Preparation/Storage; Marrow Ablative Therapy; Drugs Supplies Hospitalization With Outpatient Follow-Up; Medical/Surgical Diagnostic Emergency And Rehabilitative Services; And The Number Of Days Of Pre-And Post- Transplant Care In The Global Definition2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 222 Original policy
99183Physician Or Other Qualified Health Care Professional Attendance And Supervision Of Hyperbaric Oxygen Therapy Per Session2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 222 Original policy
63032Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; with repair of annular defect by implantation of bone-anchored annular closure device, including all imaging guidance, 1 interspace, lumbar (List separately in addition to code for primary procedure)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 38 Original policy
70471Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 53 Original policy
70472Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 53 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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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