Blue Shield of California Promise Health Plan prior authorization, page 31
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 |
|---|---|---|
| Q5147 | aflibercept-ayyh (Pavblu) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5148 | filgrastim-txid (nypozi) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5149 | aflibercept-abzv (enzeevu) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5150 | aflibercept-mrbb (ahzantive) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5151 | eculizumab-aagh (epysqli) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5152 | eculizumab-aeeb (bkemv) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5153 | aflibercept-yszy (opuviz) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5154 | omalizumab-igec (Omlyclo) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5155 | aflibercept-jbvf (Yesafili) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5156 | tocilizumab-anoh (Avtozma) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5157 | denosumab-bmwo (Stoboclo) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5158 | denosumab-bnht (Bomyntra) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5159 | denosumab-dssb (Ospomyv) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5160 | bevacizumab-nwgd (Jobevne) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5161 | denosumab-kyqq (aukelso/bosaya) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5162 | denosumab-nxxp (bildyos/bilprevda) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5164 | ustekinumab-hmny (Starjemza) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5165 | denosumab-mobz (Oziltus) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5166 | denosumab-desu (Osvyrti/Jubereq) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5167 | denosumab-qbde (Xtrenbo) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5168 | ranibizumab-leyk (Nufymco) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5169 | pegfilgrastim-unne (Armlupeg) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5170 | aflibercept-boav (Eydenzelt) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q5171 | denosumab-mobz (Boncresa) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q9996 | ustekinumab-ttwe (pyzchiva) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q9997 | ustekinumab-ttwe (pyzchiva) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q9998 | ustekinumab-aekn (selarsdi) | Medi-Cal Prior Authorization List, Pg 61 Original policy |
| Q9999 | ustekinumab-aauz (otulfi) | Medi-Cal Prior Authorization List, Pg 61 Original policy |