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Blue Cross Blue Shield Oklahoma prior authorization, page 35

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
E1007Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 246 Original policy
E1239Power wheelchair, pediatric size, not otherwise specified2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 246 Original policy
E1701Replacement cushions for jaw motion rehabilitation system, pkg. of 62026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 246 Original policy
E1702Replacement measuring scales for jaw motion rehabilitation system, pkg. of 2002026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 246 Original policy
E2301Wheelchair accessory, power standing system, any type2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 246 Original policy
E2311Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
E2510Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
G0563Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
G0682Application of a premarket approval (pma), 510(k), 361 human cells, tissues or cellular and tissue-based products (hct/p) non-sheet form skin substitute for a wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
J3145Injection, testosterone undecanoate, 1 mg2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
K0014Other motorized/power wheelchair base2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
K0820Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 247 Original policy
K0826Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0829Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0840Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0851Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0852Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0854Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0855Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0861Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0868Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0869Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 248 Original policy
K0870Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0871Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0877Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0878Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0879Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0880Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0885Power wheelchair, group 4 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
K0886Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
L2221Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
L5610Addition to lower extremity, endoskeletal system, above knee, hydracadence system2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 249 Original policy
L5638Addition to lower extremity, below knee, leather socket2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5639Addition to lower extremity, below knee, wood socket2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5644Addition to lower extremity, above knee, wood socket2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5672Addition to lower extremity, below knee, removable medial brim suspension2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5712Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5714Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5716Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5718Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5722Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5724Addition, exoskeletal knee-shin system, single axis, fluid swing phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5726Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5728Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5780Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 250 Original policy
L5795Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 251 Original policy
L5816Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 251 Original policy
L5841Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 251 Original policy
L5857Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 251 Original policy
L5858Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type2026 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes, Pg 251 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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