Blue Shield of California Promise Health Plan 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 |
|---|---|---|
| E0271 | MATTRESS INNER SPRING | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0272 | MATTRESS FOAM RUBBER | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0277 | POWERED PRESSURE-REDUCING AIR MATTRESS | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0293 | HOSP BED VAR HT NO SR NO MAT | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0295 | HOSP BED SEMI-ELEC W/O SIDE RAILS W/O MATTRSS | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0297 | HOSP BED TOTAL ELEC W/O SIDE RAILS W/O MATTRSS | Medi-Cal Prior Authorization List, Pg 20 Original policy |
| E0303 | HOS BED HEVY DUTY W/WT CAP >350 PDS</=TO 600 PDS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0304 | HOS BED EXTRA HEAVY-DUTY WT CAP>600 PDS MATTRSS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0305 | BEDSIDE RAILS HALF-LENGTH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0310 | BEDSIDE RAILS FULL-LENGTH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0316 | SFTY ENCLOS FRME/CANOPY USE W/HOSP BED ANY TYPE | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0328 | HOSPITAL BED PEDIATRIC MANUAL INCLUDES MATTRESS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0329 | HOSPITAL BED PEDIATRIC ELECTRIC INCLUDE MATTRESS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0371 | NONPWR ADV PRSS RDUC OVRLAY MATTRSS STD LEN&WDTH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0372 | PWR AIR OVRLAY MATTRSS STD MATTRSS LENGTH&WIDTH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0373 | NONPOWERED ADVANCED PRESSURE REDUCING MATTRESS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0424 | STATION COMPRS GASOUS O2 SYS RENT; FLWMTR HUMIDFR | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0431 | PRTBLE GASEOUS O2 SYS RENT; FLWMTR HUMIDFR&MASK | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0441 | STATIONARY O2 CONTENTS GAS 1 MO SUPPLY=1 UNIT | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0465 | HOME VENT INVASIVE INTERFACE | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0466 | HOME VENT NON-INVASIVE INTER | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0467 | Home ventilator | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0470 | RESP ASST DEVC BI-LEVL PRSS CAPABILITY W/O BACKU | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0471 | RESP ASST DEVC BI-LEVL PRSS CAPABILITY W/BACK-UP | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0481 | INTRAPULM PERCUSSIVE VENT SYSTEM&REL ACSSORIES | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0482 | COUGH STIM DEVICE ALTRNAT POS&NEG ARWAY PRESS | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0486 | ORL DEVC/APPL RDUC UP AIRWAY COLLAPSIBILITY CSTM | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0565 | COMPRS AIR PWR EQP NOT SLF-CONTAIND/CYL DRIVN | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0621 | SLING OR SEAT PATIENT LIFT CANVAS OR NYLON | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0630 | PATIENT LIFT HYDRAULIC/MECH INCL SEAT SLING/PAD | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0635 | PATIENT LIFT ELECTRIC WITH SEAT OR SLING | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0747 | OSTOGNS STIM ELEC NONINVASV OTH THAN SP APPLIC | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0748 | OSTOGNS STIMULATOR ELEC NONINVASV SPINAL APPLIC | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0760 | OSTOGNS STIM LOW INTENS ULTRASOUND NON-INVASV | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0766 | Electric Stimulation Device for Cancer Treatment | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0910 | TRAPEZ BAR KNOWN AS PT HLPR ATTCH BED W/GRAB BAR | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0911 | TRAPEZ BAR HEVY DUTY PT WT >250 LBS BED GRAB BAR | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0912 | TRAPEZ BAR HEVY DUTY PT WT > 250 LBS FREE STAND | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0940 | TRAPEZE BAR FREESTANDING COMPLETE WITH GRAB BAR | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0950 | WHEELCHAIR ACCESSORY TRAY EACH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0951 | HEEL LOOP/HOLDER TYPE W/WO ANKLE STRAP EACH | Medi-Cal Prior Authorization List, Pg 21 Original policy |
| E0952 | TOE LOOP/HOLDER ANY TYPE EACH | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0953 | WHEELCHAIR ACCESSORY LAT THIGH | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0954 | WHEELCHAIR ACCESSORY FOOT BOX | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0955 | WC ACSS HEADREST CUSHNED FIX MOUNT HARDWARE EA | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0956 | WC ACSS LAT TRNK/HIP SUPP FIX MOUNT HARDWARE EA | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0957 | WC ACSS MED THI SUPP FIX MOUNT HARDWARE EA | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0960 | WC ACSS SHLDR HRNSS/STRAPS/CHST STRAP W/TYPE MOU | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0961 | MANUAL WHEELCHAIR ACCESS WHEEL LOCK BRAKE EXT EA | Medi-Cal Prior Authorization List, Pg 22 Original policy |
| E0966 | MANUAL WHEELCHAIR ACCESS HEADREST EXTENSION EA | Medi-Cal Prior Authorization List, Pg 22 Original policy |