Talk to Us

Blue Cross Blue Shield Oklahoma prior authorization, page 31

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
S9363Hit Anti-Spasmotic Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 220 Original policy
S9364Home Infusion Therapy Total Parenteral Nutrition (Tpn); Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment Including Standard Tpn Formula (Lipids Specialty Amino Acid Formulas Drugs Other Than In Standard Formula And Nursing Visits Coded Separately) Per Diem (Do Not Use With Home Infusion Codes S9365-S9368 Using Daily Volume Scales)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 220 Original policy
S9365Home Infusion Therapy Total Parenteral Nutrition (Tpn); One Liter Per Day Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment Including Standard Tpn Formula (Lipids Specialty Amino Acid Formulas Drugs Other Than In Standard Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 221 Original policy
S9366Home Infusion Therapy Total Parenteral Nutrition (Tpn); More Than One Liter But No More Than Two Liters Per Day Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment Including Standard Tpn Formula (Lipids Specialty Amino Acid Formulas Drugs Other Than In Standard Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 221 Original policy
S9367Home Infusion Therapy Total Parenteral Nutrition (Tpn); More Than Two Liters But No More Than Three Liters Per Day Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment Including Standard Tpn Formula (Lipids Specialty Amino Acid Formulas Drugs Other Than In Standard Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 221 Original policy
S9368Home Infusion Therapy Total Parenteral Nutrition (Tpn); More Than Three Liters Per Day Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment Including Standard Tpn Formula (Lipids Specialty Amino Acid Formulas Drugs Other Than In Standard Formula And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 222 Original policy
S9370Ht Inj Antiemetic Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 222 Original policy
S9374Hit Hydra 1 Liter Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 222 Original policy
S9377Hit Hydra Over 3L Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 223 Original policy
S9379Home Infusion Therapy Infusion Therapy Not Otherwise Classified; Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 223 Original policy
S9490Hit Corticosteroid/Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 223 Original policy
S9503Hit Antibiotic Q6H Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 224 Original policy
S9504Hit Antibiotic Q4H Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 224 Original policy
S9529Venipuncture Home/Snf2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 224 Original policy
S9537Home Therapy; Hematopoietic Hormone Injection Therapy (E. G. Erythropoietin G-Csf Gm- Csf); Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9538Hit Blood Products Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9542Home Injectable Therapy Not Otherwise Classified Including Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9558Home Injectable Therapy; Growth Hormone Including Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9559Hit Inj Interferon Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9560Home Injectable Therapy; Hormonal Therapy (E. G. ; Leuprolide Goserelin) Including Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 225 Original policy
S9562Home Injectable Therapy Palivizumab Or Other Monoclonal Antibody For Rsv Including Administrative Services Professional Pharmacy Services Care Coordination And All Necessary Supplies And Equipment (Drugs And Nursing Visits Coded Separately) Per Diem2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 226 Original policy
0632URed blood cell antigen, fetal RHD gene analysis using multiplex PCR and next-generation sequencing of circulating cell-free DNA2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 226 Original policy
0633UObstetrics single-gene noninvasive prenatal test using circulating cell-free DNA and next- generation sequencing2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 226 Original policy
0635UArtificial intelligence analysis of mRNA gene expression profiling, 487 genes, noninvasive2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 226 Original policy
0641UOncology minimal residual disease tumor DNA analysis using next-generation sequencing of FFPE tissue and blood sample, initial test2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 226 Original policy
0642UOncology minimal residual disease tumor DNA analysis using next-generation sequencing of whole blood, comparison to previous analysis2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
0643UOncology genitourinary cancer circulating tumor DNA analysis, 200 genes, NGS interrogation of SNVs and indels2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
0649UNeurology Alzheimer’s disease DNA targeted analysis using next-generation sequencing of AD- related genes from whole blood2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
0651UOncology hereditary cancer genomic DNA analysis of 55 genes using NGS and deletion/duplication analysis (MLPA)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
C1767Generator, neurostimulator (implantable), non- rechargeable2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
C9762Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction, with strain imaging2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
C9763Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction, with stress imaging2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11950Subcutaneous injection of filling material (eg, collagen); 1 cc or less2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11951Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11952Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11954Subcutaneous injection of filling material (eg, collagen); over 10.0 cc2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11980Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 227 Original policy
11981Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non- biodegradable)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15271Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15275Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15780Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15781Dermabrasion; segmental, face2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15782Dermabrasion; regional, other than face2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15783Dermabrasion; superficial, any site (eg, tattoo removal)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15788Chemical peel, facial; epidermal2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15789Chemical peel, facial; dermal2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15820Blepharoplasty, lower eyelid2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15821Blepharoplasty, lower eyelid; with extensive herniated fat pad2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15822Blepharoplasty, upper eyelid2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 228 Original policy
15823Blepharoplasty, upper eyelid; with excessive skin weighting down lid2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 229 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.

This website uses cookies to ensure you get the best experience on our website. Learn more