Blue Cross Blue Shield Oklahoma prior authorization, page 7
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 |
|---|---|---|
| 92633 | Auditory Rehabilitation; Postlingual Hearing Loss | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8614 | Cochlear Device Includes All Internal And External Components | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8615 | Headset/Headpiece For Use With Cochlear Implant Device Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8616 | Microphone For Use With Cochlear Implant Device Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8617 | Transmitting Coil For Use With Cochlear Implant Device Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8618 | Transmitter Cable For Use With Cochlear Implant Device Or Auditory Osseointegrated Device Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8619 | Cochlear Implant External Speech Processor And Controller Integrated System Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8621 | Zinc Air Battery For Use With Cochlear Implant Device And Auditory Osseointegrated Sound Processors Replacement Each | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8622 | Alkaline Battery For Use With Cochlear Implant Device Any Size Replacement Each | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8623 | Lithium Ion Battery For Use With Cochlear Implant Device Speech Processor Other Than Ear Level Replacement Each | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8624 | Lithium Ion Battery For Use With Cochlear Implant Or Auditory Osseointegrated Device Speech Processor Ear Level Replacement Each | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8627 | Cochlear Implant External Speech Processor Component Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 36 Original policy |
| L8628 | Cochlear Implant External Controller Component Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| L8629 | Transmitting Coil And Cable Integrated For Use With Cochlear Implant Device Replacement | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| L8690 | Auditory Osseointegrated Device Includes All Internal And External Components | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| L8691 | Auditory Osseointegrated Device External Sound Processor Excludes Transducer/Actuator Replacement Only Each | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| L8693 | Auditory Osseointegrated Device Abutment Any Length Replacement Only | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| 43647 | Laparoscopy Surgical; Implantation Or Replacement Of Gastric Neurostimulator Electrodes Antrum | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| 43648 | Laparoscopy Surgical; Revision Or Removal Of Gastric Neurostimulator Electrodes Antrum | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| 43881 | Implantation Or Replacement Of Gastric Neurostimulator Electrodes Antrum Open | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| 95980 | Electronic Analysis Of Implanted Neurostimulator Pulse Generator System (Eg Rate Pulse Amplitude And Duration Configuration Of Wave Form Battery Status Electrode Selectability Output Modulation Cycling Impedance And Patient Measurements) Gastric Neurostimulator Pulse Generator/Transmitter; Intraoperative With Programming | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 37 Original policy |
| E0765 | Fda Approved Nerve Stimulator With Replaceable Batteries For Treatment Of Nausea And Vomiting | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 38 Original policy |
| S5501 | Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 38 Original policy |
| S5502 | Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 38 Original policy |
| S9208 | Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 38 Original policy |
| S9209 | Home management of preterm premature rupture of membranes (pprom), including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 39 Original policy |
| S9211 | Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 39 Original policy |
| S9212 | Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 39 Original policy |
| S9213 | Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 40 Original policy |
| S9214 | Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 40 Original policy |
| S9325 | Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with s9326, s9327 or s9328) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 40 Original policy |
| S9357 | Home infusion therapy, enzyme replacement intravenous therapy; (e. G. Imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 40 Original policy |
| S9359 | Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e. G. Infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 41 Original policy |
| S9372 | Home therapy; intermittent anticoagulant injection therapy (e. G. Heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code for flushing of infusion devices with heparin to maintain patency) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 41 Original policy |
| S9373 | Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes s9374-s9377 using daily volume scales) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 41 Original policy |
| S9375 | Home infusion therapy, hydration therapy; 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 (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 42 Original policy |
| S9376 | Home infusion therapy, hydration therapy; 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 (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 42 Original policy |
| S9494 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules s9497-s9504) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 42 Original policy |
| S9497 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 42 Original policy |
| S9500 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 43 Original policy |
| S9501 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 43 Original policy |
| S9502 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 43 Original policy |
| S9590 | Home therapy, irrigation therapy (e. G. Sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 43 Original policy |
| S9810 | Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 44 Original policy |
| 0575U | Transplantation medicine (liver allograft rejection), miRNA gene expression profiling by RT-PCR of 4 genes (miR-122, miR-885, miR-23a housekeeping, spike-in control), serum, algorithm reported as risk of liver allograft rejection | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 44 Original policy |
| 0576U | Transplantation medicine (liver allograft rejection), quantitative donor- derived cell-free DNA (cfDNA) by (cid:90)(cid:75)(cid:82)(cid:79)(cid:72)(cid:3)(cid:74)(cid:72)(cid:81)(cid:82)(cid:80)(cid:72)(cid:3)(cid:81)(cid:72)(cid:91)(cid:87)(cid:31)(cid:74)(cid:72)(cid:81)(cid:72)(cid:85)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3) sequencing, plasma and mRNA gene expression profiling by multiplex real-time PCR of 56 genes, whole blood, combined algorithm reported as a rejection risk score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 44 Original policy |
| 0578U | Oncology (cutaneous melanoma), RNA, gene expression profiling by (cid:85)(cid:72)(cid:68)(cid:79)(cid:31)(cid:87)(cid:76)(cid:80)(cid:72)(cid:3)(cid:84)(cid:51)(cid:38)(cid:53)(cid:3)(cid:82)(cid:73)(cid:3)(cid:20)(cid:19)(cid:3)(cid:74)(cid:72)(cid:81)(cid:72)(cid:86)(cid:3)(cid:11)(cid:27)(cid:3) content and 2 housekeeping), utilizing formalin-fixed paraffin- embedded (FFPE) tissue, algorithm reports a binary result, either low-risk or high-risk for sentinel lymph node metastasis and recurrence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 44 Original policy |
| 0582U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome DNA sequencing for (cid:86)(cid:76)(cid:81)(cid:74)(cid:79)(cid:72)(cid:31)(cid:81)(cid:88)(cid:70)(cid:79)(cid:72)(cid:82)(cid:87)(cid:76)(cid:71)(cid:72)(cid:3)(cid:89)(cid:68)(cid:85)(cid:76)(cid:68)(cid:81)(cid:87)(cid:86)(cid:15)(cid:3) insertions/deletions, copy number variations, blood, saliva, tissue sample, variants reported | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 45 Original policy |
| 0583U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome comparator DNA sequencing for single-nucleotide variants, insertions/deletions, copy number variations, blood, saliva, tissue sample, variants reported with proband results | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 45 Original policy |
| 0585U | Targeted genomic sequence analysis panel, solid organ neoplasm, circulating cell-free DNA (cfDNA) analysis from plasma of 521 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, and microsatellite instability, report shows identified mutations, including variants with clinical actionability | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 45 Original policy |