Blue Cross Blue Shield Oklahoma prior authorization, page 9
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 |
|---|---|---|
| 81217 | Brca2 (Brca2 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 |
| 81218 | Cebpa (Ccaat/Enhancer Binding Protein [C/Ebp] Alpha) (Eg Acute Myeloid Leukemia) Gene Analysis Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 52 Original policy |
| 81219 | Calr (Calreticulin) (Eg Myeloproliferative Disorders) Gene Analysis Common Variants In Exon 9 | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81221 | Cftr (Cystic Fibrosis Transmembrane Conductance Regulator) (Eg Cystic Fibrosis) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81222 | Cftr (Cystic Fibrosis Transmembrane Conductance Regulator) (Eg Cystic Fibrosis) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81223 | Cftr (Cystic Fibrosis Transmembrane Conductance Regulator) (Eg Cystic Fibrosis) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81224 | Cftr (Cystic Fibrosis Transmembrane Conductance Regulator) (Eg Cystic Fibrosis) Gene Analysis; Intron 8 Poly-T Analysis (Eg Male Infertility) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81225 | Cyp2C19 (Cytochrome P450 Family 2 Subfamily C Polypeptide 19) (Eg Drug Metabolism) Gene Analysis Common Variants (Eg *2 *3 *4 *8 *17) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81226 | Cyp2D6 (Cytochrome P450 Family 2 Subfamily D Polypeptide 6) (Eg Drug Metabolism) Gene Analysis Common Variants (Eg *2 *3 *4 *5 *6 *9 *10 *17 *19 *29 *35 *41 *1Xn *2Xn *4Xn) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 53 Original policy |
| 81227 | Cyp2C9 (Cytochrome P450 Family 2 Subfamily C Polypeptide 9) (Eg Drug Metabolism) Gene Analysis Common Variants (Eg *2 *3 *5 *6) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81228 | Cytogenomic (Genome-Wide) Analysis For Constitutional Chromosomal Abnormalities; Interrogation Of Genomic Regions For Copy Number Variants Comparative Genomic Hybridization [Cgh] Microarray Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81229 | Cytogenomic (Genome-Wide) Analysis For Constitutional Chromosomal Abnormalities; Interrogation Of Genomic Regions For Copy Number And Single Nucleotide Polymorphism (Snp) Variants Comparative Genomic Hybridization (Cgh) Microarray Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81230 | Cyp3A4 (Cytochrome P450 Family 3 Subfamily A Member 4) (Eg Drug Metabolism) Gene Analysis Common Variant(S) (Eg *2 *22) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81231 | Cyp3A5 (Cytochrome P450 Family 3 Subfamily A Member 5) (Eg Drug Metabolism) Gene Analysis Common Variants (Eg *2 *3 *4 *5 *6 *7) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81232 | Dpyd (Dihydropyrimidine Dehydrogenase) (Eg 5- Fluorouracil/5-Fu And Capecitabine Drug Metabolism) Gene Analysis Common Variant(S) (Eg *2A *4 *5 *6) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 54 Original policy |
| 81233 | Btk (Bruton'S Tyrosine Kinase) (Eg Chronic Lymphocytic Leukemia) Gene Analysis Common Variants (Eg C481S C481R C481F) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81234 | Dmpk (Dm1 Protein Kinase) (Eg Myotonic Dystrophy Type 1) Gene Analysis; Evaluation To Detect Abnormal (Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81235 | Egfr (Epidermal Growth Factor Receptor) (Eg Non-Small Cell Lung Cancer) Gene Analysis Common Variants (Eg Exon 19 Lrea Deletion L858R T790M G719A G719S L861Q) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81236 | Ezh2 (Enhancer Of Zeste 2 Polycomb Repressive Complex 2 Subunit) (Eg Myelodysplastic Syndrome Myeloproliferative Neoplasms) Gene Analysis Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81237 | Ezh2 (Enhancer Of Zeste 2 Polycomb Repressive Complex 2 Subunit) (Eg Diffuse Large B-Cell Lymphoma) Gene Analysis Common Variant(S) (Eg Codon 646) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81238 | F9 (Coagulation Factor Ix) (Eg Hemophilia B) Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81239 | Dmpk (Dm1 Protein Kinase) (Eg Myotonic Dystrophy Type 1) Gene Analysis; Characterization Of Alleles (Eg Expanded Size) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81240 | F2 (Prothrombin Coagulation Factor Ii) (Eg Hereditary Hypercoagulability) Gene Analysis 20210G>A Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 55 Original policy |
| 81242 | Fancc (Fanconi Anemia Complementation Group C) (Eg Fanconi Anemia Type C) Gene Analysis Common Variant (Eg Ivs4+4A>T) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81244 | Fmr1 (Fragile X Messenger Ribonucleoprotein 1) (Eg Fragile X Syndrome X-Linked Intellectual Disability [Xlid]) Gene Analysis; Characterization Of Alleles (Eg Expanded Size And Promoter Methylation Status) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81245 | Flt3 (Fms-Related Tyrosine Kinase 3) (Eg Acute Myeloid Leukemia) Gene Analysis; Internal Tandem Duplication (Itd) Variants (Ie Exons 14 15) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81246 | Flt3 (Fms-Related Tyrosine Kinase 3) (Eg Acute Myeloid Leukemia) Gene Analysis; Tyrosine Kinase Domain (Tkd) Variants (Eg D835 I836) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81247 | G6Pd (Glucose-6-Phosphate Dehydrogenase) (Eg Hemolytic Anemia Jaundice) Gene Analysis; Common Variant(S) (Eg A A-) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81248 | G6Pd (Glucose-6-Phosphate Dehydrogenase) (Eg Hemolytic Anemia Jaundice) Gene Analysis; Known Familial Variant(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81249 | G6Pd (Glucose-6-Phosphate Dehydrogenase) (Eg Hemolytic Anemia Jaundice) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81250 | G6Pc (Glucose-6-Phosphatase Catalytic Subunit) (Eg Glycogen Storage Disease Type 1A Von Gierke Disease) Gene Analysis Common Variants (Eg R83C Q347X) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 56 Original policy |
| 81251 | Gba (Glucosidase Beta Acid) (Eg Gaucher Disease) Gene Analysis Common Variants (Eg N370S 84Gg L444P Ivs2+1G>A) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81252 | Gjb2 (Gap Junction Protein Beta 2 26Kda Connexin 26) (Eg Nonsyndromic Hearing Loss) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81253 | Gjb2 (Gap Junction Protein Beta 2 26Kda Connexin 26) (Eg Nonsyndromic Hearing Loss) Gene Analysis; Known Familial Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81254 | Gjb6 (Gap Junction Protein Beta 6 30Kda Connexin 30) (Eg Nonsyndromic Hearing Loss) Gene Analysis Common Variants (Eg 309Kb [Del(Gjb6-D13S1830)] And 232Kb [Del(Gjb6-D13S1854)]) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81255 | Hexa (Hexosaminidase A [Alpha Polypeptide]) (Eg Tay-Sachs Disease) Gene Analysis Common Variants (Eg 1278Instatc 1421+1G>C G269S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81256 | Hfe (Hemochromatosis) (Eg Hereditary Hemochromatosis) Gene Analysis Common Variants (Eg C282Y H63D) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81257 | Hba1/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syndrome Hbh Disease) Gene Analysis; Common Deletions Or Variant (Eg Southeast Asian Thai Filipino Mediterranean Alpha3.7 Alpha4.2 Alpha20.5 Constant Spring) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 57 Original policy |
| 81258 | Hba1/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syndrome Hbh Disease) Gene Analysis; Known Familial Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81259 | Hba1/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syndrome Hbh Disease) Gene Analysis; Full Gene Sequence | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81260 | Ikbkap (Inhibitor Of Kappa Light Polypeptide Gene Enhancer In B- Cells Kinase Complex-Associated Protein) (Eg Familial Dysautonomia) Gene Analysis Common Variants (Eg 2507+6T>C R696P) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81261 | Igh@ (Immunoglobulin Heavy Chain Locus) (Eg Leukemias And Lymphomas B-Cell) Gene Rearrangement Analysis To Detect Abnormal Clonal Population(S); Amplified Methodology (Eg Polymerase Chain Reaction) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81262 | Igh@ (Immunoglobulin Heavy Chain Locus) (Eg Leukemias And Lymphomas B-Cell) Gene Rearrangement Analysis To Detect Abnormal Clonal Population(S); Direct Probe Methodology (Eg Southern Blot) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81263 | Igh@ (Immunoglobulin Heavy Chain Locus) (Eg Leukemia And Lymphoma B-Cell) Variable Region Somatic Mutation Analysis | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 58 Original policy |
| 81264 | Igk@ (Immunoglobulin Kappa Light Chain Locus) (Eg Leukemia And Lymphoma B-Cell) Gene Rearrangement Analysis Evaluation To Detect Abnormal Clonal Population(S) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 59 Original policy |
| 81265 | Comparative Analysis Using Short Tandem Repeat (Str) Markers; Patient And Comparative Specimen (Eg Pre-Transplant Recipient And Donor Germline Testing Post- Transplant Non-Hematopoietic Recipient Germline [Eg Buccal Swab Or Other Germline Tissue Sample] And Donor Testing Twin Zygosity Testing Or Maternal Cell Contamination Of Fetal Cells) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 59 Original policy |
| 81266 | Comparative Analysis Using Short Tandem Repeat (Str) Markers; Each Additional Specimen (Eg Additional Cord Blood Donor Additional Fetal Samples From Different Cultures Or Additional Zygosity In Multiple Birth Pregnancies) (List Separately In Addition To Code For Primary Procedure) | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 59 Original policy |
| 81269 | Hba1/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syndrome Hbh Disease) Gene Analysis; Duplication/Deletion Variants | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 59 Original policy |
| 81270 | Jak2 (Janus Kinase 2) (Eg Myeloproliferative Disorder) Gene Analysis P.Val617Phe (V617F) Variant | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 59 Original policy |
| 81271 | Htt (Huntingtin) (Eg Huntington Disease) Gene Analysis; Evaluation To Detect Abnormal (Eg Expanded) Alleles | 2026 Commercial Outpatient Medical Surgical Fully Insured Prior Authorization Codes, Pg 60 Original policy |