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Blue Cross Blue Shield Oklahoma prior authorization, page 6

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
78433Myocardial Imaging Positron Emission Tomography (Pet) Combined Perfusion With Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed) Dual Radiotracer (Eg Myocardial Viability); With Concurrently Acquired Computed Tomography Transmission Scan2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 28 Original policy
78451Myocardial Perfusion Imaging Tomographic (Spect) (Including Attenuation Correction Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Single Study At Rest Or Stress (Exercise Or Pharmacologic)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 29 Original policy
78452Myocardial Perfusion Imaging Tomographic (Spect) (Including Attenuation Correction Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Multiple Studies At Rest And/Or Stress (Exercise Or Pharmacologic) And/Or Redistribution And/Or Rest Reinjection2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 29 Original policy
78453Myocardial Perfusion Imaging Planar (Including Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Single Study At Rest Or Stress (Exercise Or Pharmacologic)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 29 Original policy
78454Myocardial Perfusion Imaging Planar (Including Qualitative Or Quantitative Wall Motion Ejection Fraction By First Pass Or Gated Technique Additional Quantification When Performed); Multiple Studies At Rest And/Or Stress (Exercise Or Pharmacologic) And/Or Redistribution And/Or Rest Reinjection2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 29 Original policy
78459Myocardial Imaging Positron Emission Tomography (Pet) Metabolic Evaluation Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed) Single Study2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78466Myocardial Imaging Infarct Avid Planar; Qualitative Or Quantitative2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78468Myocardial Imaging Infarct Avid Planar; With Ejection Fraction By First Pass Technique2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78469Myocardial Imaging Infarct Avid Planar; Tomographic Spect With Or Without Quantification2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78472Cardiac Blood Pool Imaging Gated Equilibrium; Planar Single Study At Rest Or Stress (Exercise And/Or Pharmacologic) Wall Motion Study Plus Ejection Fraction With Or Without Additional Quantitative Processing2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78473Cardiac Blood Pool Imaging Gated Equilibrium; Multiple Studies Wall Motion Study Plus Ejection Fraction At Rest And Stress (Exercise And/Or Pharmacologic) With Or Without Additional Quantification2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78481Cardiac Blood Pool Imaging (Planar) First Pass Technique; Single Study At Rest Or With Stress (Exercise And/Or Pharmacologic) Wall Motion Study Plus Ejection Fraction With Or Without Quantification2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 30 Original policy
78483Cardiac Blood Pool Imaging (Planar) First Pass Technique; Multiple Studies At Rest And With Stress (Exercise And/Or Pharmacologic) Wall Motion Study Plus Ejection Fraction With Or Without Quantification2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
78491Myocardial Imaging Positron Emission Tomography (Pet) Perfusion Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed); Single Study At Rest Or Stress (Exercise Or Pharmacologic)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
78492Myocardial Imaging Positron Emission Tomography (Pet) Perfusion Study (Including Ventricular Wall Motion[S] And/Or Ejection Fraction[S] When Performed); Multiple Studies At Rest And Stress (Exercise Or Pharmacologic)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
78494Cardiac Blood Pool Imaging Gated Equilibrium Spect At Rest Wall Motion Study Plus Ejection Fraction With Or Without Quantitative Processing2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
78496Cardiac Blood Pool Imaging Gated Equilibrium Single Study At Rest With Right Ventricular Ejection Fraction By First Pass Technique (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
93303Transthoracic Echocardiography For Congenital Cardiac Anomalies; Complete2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
93304Transthoracic Echocardiography For Congenital Cardiac Anomalies; Follow-Up Or Limited Study2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 31 Original policy
93306Echocardiography Transthoracic Real-Time With Image Documentation (2D) Includes M- Mode Recording When Performed Complete With Spectral Doppler Echocardiography And With Color Flow Doppler Echocardiography2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93307Echocardiography Transthoracic Real-Time With Image Documentation (2D) Includes M- Mode Recording When Performed Complete Without Spectral Or Color Doppler Echocardiography2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93308Echocardiography Transthoracic Real-Time With Image Documentation (2D) Includes M- Mode Recording When Performed Follow-Up Or Limited Study2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93312Echocardiography Transesophageal Real-Time With Image Documentation (2D) (With Or Without M-Mode Recording); Including Probe Placement Image Acquisition Interpretation And Report2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93313Echocardiography Transesophageal Real-Time With Image Documentation (2D) (With Or Without M-Mode Recording); Placement Of Transesophageal Probe Only2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93314Echocardiography Transesophageal Real-Time With Image Documentation (2D) (With Or Without M-Mode Recording); Image Acquisition Interpretation And Report Only2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 32 Original policy
93315Transesophageal Echocardiography For Congenital Cardiac Anomalies; Including Probe Placement Image Acquisition Interpretation And Report2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93316Transesophageal Echocardiography For Congenital Cardiac Anomalies; Placement Of Transesophageal Probe Only2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93317Transesophageal Echocardiography For Congenital Cardiac Anomalies; Image Acquisition Interpretation And Report Only2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93320Doppler Echocardiography Pulsed Wave And/Or Continuous Wave With Spectral Display (List Separately In Addition To Codes For Echocardiographic Imaging); Complete2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93321Doppler Echocardiography Pulsed Wave And/Or Continuous Wave With Spectral Display (List Separately In Addition To Codes For Echocardiographic Imaging); Follow- Up Or Limited Study (List Separately In Addition To Codes For Echocardiographic Imaging)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93325Doppler Echocardiography Color Flow Velocity Mapping (List Separately In Addition To Codes For Echocardiography)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 33 Original policy
93350Echocardiography Transthoracic Real-Time With Image Documentation (2D) Includes M- Mode Recording When Performed During Rest And Cardiovascular Stress Test Using Treadmill Bicycle Exercise And/Or Pharmacologically Induced Stress With Interpretation And Report2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
93351Echocardiography Transthoracic Real-Time With Image Documentation (2D) Includes M- Mode Recording When Performed During Rest And Cardiovascular Stress Test Using Treadmill Bicycle Exercise And/Or Pharmacologically Induced Stress With Interpretation And Report; Including Performance Of Continuous Electrocardiographic Monitoring With Supervision By A Physician Or Other Qualified Health Care Professional2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
93352Use Of Echocardiographic Contrast Agent During Stress Echocardiography (List Separately In Addition To Code For Primary Procedure)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
36516Therapeutic Apheresis; With Extracorporeal Immunoadsorption Selective Adsorption Or Selective Filtration And Plasma Reinfusion2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
S2120Low Density Lipoprotein (Ldl) Apheresis Using Heparin-Induced Extracorporeal Ldl Precipitation2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
30120Excision Or Surgical Planing Of Skin Of Nose For Rhinophyma2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 34 Original policy
30400Rhinoplasty Primary; Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30410Rhinoplasty Primary; Complete External Parts Including Bony Pyramid Lateral And Alar Cartilages And/Or Elevation Of Nasal Tip2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30420Rhinoplasty Primary; Including Major Septal Repair2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30430Rhinoplasty Secondary; Minor Revision (Small Amount Of Nasal Tip Work)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30435Rhinoplasty Secondary; Intermediate Revision (Bony Work With Osteotomies)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30450Rhinoplasty Secondary; Major Revision (Nasal Tip Work And Osteotomies)2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
30999Unlisted Procedure Nose2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
31296Nasal/Sinus Endoscopy Surgical With Dilation (Eg Balloon Dilation); Frontal Sinus Ostium2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
31297Nasal/Sinus Endoscopy Surgical With Dilation (Eg Balloon Dilation); Sphenoid Sinus Ostium2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
31299Unlisted Procedure Accessory Sinuses2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
69714Implantation Osseointegrated Implant Skull; With Percutaneous Attachment To External Speech Processor2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
69717Replacement (Including Removal Of Existing Device) Osseointegrated Implant Skull; With Percutaneous Attachment To External Speech Processor2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 Original policy
69930Cochlear Device Implantation With Or Without Mastoidectomy2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 35 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.

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