Blue Cross Blue Shield Oklahoma prior authorization, page 8
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 |
|---|---|---|
| 0586U | Oncology, mRNA, gene expression profiling of 216 genes (204 targeted and 12 housekeeping genes), RNA expression analysis, formalin-fixed paraffin-embedded (FFPE) tissue, quantitative, reported as log2 ratio per gene | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 45 Original policy |
| 0592U | Oncology (hematolymphoid neoplasms), DNA, targeted genomic sequence of 417 genes, interrogation for gene fusions, translocations, rearrangements, utilizing formalin-fixed paraffin- embedded (FFPE) tumor tissue, results report clinically significant variant(s) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 46 Original policy |
| 0597U | Oncology (breast), RNA expression profiling of 329 genes by targeted nextgeneration sequencing and 20 proteins by multiplex immunofluorescence, formalin-fixed paraffin-embedded (FFPE) tissue, algorithmic analyses to determine tumor-recurrence risk score | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 46 Original policy |
| 81120 | Idh1 (Isocitrate Dehydrogenase 1 [Nadp+] Soluble) (Eg Glioma) Common Variants (Eg R132H R132C) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 46 Original policy |
| 81121 | Idh2 (Isocitrate Dehydrogenase 2 [Nadp+] Mitochondrial) (Eg Glioma) Common Variants (Eg R140W R172M) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 46 Original policy |
| 81162 | Brca1 (Brca1 Dna Repair Associated) Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Sequence Analysis And Full Duplication/Deletion Analysis (Ie Detection Of Large Gene Rearrangements) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 46 Original policy |
| 81163 | Brca1 (Brca1 Dna Repair Associated) Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81164 | Brca1 (Brca1 Dna Repair Associated) Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Duplication/Deletion Analysis (Ie Detection Of Large Gene Rearrangements) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81165 | Brca1 (Brca1 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81166 | Brca1 (Brca1 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Duplication/Deletion Analysis (Ie Detection Of Large Gene Rearrangements) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81167 | Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Duplication/Deletion Analysis (Ie Detection Of Large Gene Rearrangements) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81168 | Ccnd1/Igh (T(11;14)) (Eg Mantle Cell Lymphoma) Translocation Analysis Major Breakpoint Qualitative And Quantitative If Performed | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 47 Original policy |
| 81170 | Abl1 (Abl Proto-Oncogene 1 Non- Receptor Tyrosine Kinase) (Eg Acquired Imatinib Tyrosine Kinase Inhibitor Resistance) Gene Analysis Variants In The Kinase Domain | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81171 | Aff2 (Alf Transcription Elongation Factor 2 [Fmr2]) (Eg Fragile X Intellectual Disability 2 [Fraxe]) Gene Analysis; Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81172 | Aff2 (Alf Transcription Elongation Factor 2 [Fmr2]) (Eg Fragile X Intellectual Disability 2 [Fraxe]) Gene Analysis; Characterization Of Alleles (Eg Expanded Size And Methylation Status) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81173 | Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81174 | Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81175 | Asxl1 (Additional Sex Combs Like 1 Transcriptional Regulator) (Eg Myelodysplastic Syndrome Myeloproliferative Neoplasms Chronic Myelomonocytic Leukemia) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 48 Original policy |
| 81176 | Asxl1 (Additional Sex Combs Like 1 Transcriptional Regulator) (Eg Myelodysplastic Syndrome Myeloproliferative Neoplasms Chronic Myelomonocytic Leukemia) Gene Analysis; Targeted Sequence Analysis (Eg Exon 12) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81177 | Atn1 (Atrophin 1) (Eg Dentatorubral- Pallidoluysian Atrophy) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81178 | Atxn1 (Ataxin 1) (Eg Spinocerebellar Ataxia) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81179 | Atxn2 (Ataxin 2) (Eg Spinocerebellar Ataxia) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81180 | Atxn3 (Ataxin 3) (Eg Spinocerebellar Ataxia Machado-Joseph Disease) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81181 | Atxn7 (Ataxin 7) (Eg Spinocerebellar Ataxia) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81182 | Atxn8Os (Atxn8 Opposite Strand [Non-Protein Coding]) (Eg Spinocerebellar Ataxia) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81183 | Atxn10 (Ataxin 10) (Eg Spinocerebellar Ataxia) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 49 Original policy |
| 81184 | Cacna1A (Calcium Voltage-Gated Channel Subunit Alpha1 A) (Eg Spinocerebellar Ataxia) Gene Analysis; Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81185 | Cacna1A (Calcium Voltage-Gated Channel Subunit Alpha1 A) (Eg Spinocerebellar Ataxia) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81186 | Cacna1A (Calcium Voltage-Gated Channel Subunit Alpha1 A) (Eg Spinocerebellar Ataxia) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81187 | Cnbp (Cchc-Type Zinc Finger Nucleic Acid Binding Protein) (Eg Myotonic Dystrophy Type 2) Gene Analysis Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81188 | Cstb (Cystatin B) (Eg Unverricht- Lundborg Disease) Gene Analysis; Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81189 | Cstb (Cystatin B) (Eg Unverricht- Lundborg Disease) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81190 | Cstb (Cystatin B) (Eg Unverricht- Lundborg Disease) Gene Analysis; Known Familial Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81191 | Ntrk1 (Neurotrophic Receptor Tyrosine Kinase 1) (Eg Solid Tumors) Translocation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81192 | Ntrk2 (Neurotrophic Receptor Tyrosine Kinase 2) (Eg Solid Tumors) Translocation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81193 | Ntrk3 (Neurotrophic Receptor Tyrosine Kinase 3) (Eg Solid Tumors) Translocation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 50 Original policy |
| 81194 | Ntrk (Neurotrophic Receptor Tyrosine Kinase 1 2 And 3) (Eg Solid Tumors) Translocation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81195 | Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81200 | Aspa (Aspartoacylase) (Eg Canavan Disease) Gene Analysis Common Variants (Eg E285A Y231X) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81201 | Apc (Adenomatous Polyposis Coli) (Eg Familial Adenomatosis Polyposis [Fap] Attenuated Fap) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81202 | Apc (Adenomatous Polyposis Coli) (Eg Familial Adenomatosis Polyposis [Fap] Attenuated Fap) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81203 | Apc (Adenomatous Polyposis Coli) (Eg Familial Adenomatosis Polyposis [Fap] Attenuated Fap) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81204 | Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Gene Analysis; Characterization Of Alleles (Eg Expanded Size Or Methylation Status) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81205 | Bckdhb (Branched-Chain Keto Acid Dehydrogenase E1 Beta Polypeptide) (Eg Maple Syrup Urine Disease) Gene Analysis Common Variants (Eg R183P G278S E422X) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 51 Original policy |
| 81208 | Bcr/Abl1 (T(9;22)) (Eg Chronic Myelogenous Leukemia) Translocation Analysis; Other Breakpoint Qualitative Or Quantitative | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81209 | Blm (Bloom Syndrome Recq Helicase-Like) (Eg Bloom Syndrome) Gene Analysis 2281Del6Ins7 Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81210 | Braf (B-Raf Proto-Oncogene Serine/Threonine Kinase) (Eg Colon Cancer Melanoma) Gene Analysis V600 Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81212 | Brca1 (Brca1 Dna Repair Associated) Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; 185Delag 5385Insc 6174Delt Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81215 | Brca1 (Brca1 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81216 | Brca2 (Brca2 Dna Repair Associated) (Eg Hereditary Breast And Ovarian Cancer) Gene Analysis; Full Sequence Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |