Blue Shield of California prior authorization

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

Prior authorization codes
Code	Description	Source
A0430	Administrative-Medical - Air Ambulance	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9988	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9990	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9991	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9992	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9994	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9996	Administrative-Medical - Clinical Trials	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
T2043	Administrative-Medical - Continuous Home Hospice	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7168	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7169	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7170	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7175	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7180	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7181	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7182	Administrative-Medical - Factor for the	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7183	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7185	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7186	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7187	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7200	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7201	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7202	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7203	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7204	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7205	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7207	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7208	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7209	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7210	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7211	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7213	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
J7214	Treatment of Hemophilia	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5010	Administrative-Medical - Home Hospice	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9126	Administrative-Medical - Home Hospice	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
T2042	Administrative-Medical - Home Hospice	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9379	Administrative-Medical - Home Infusion	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5002	Administrative-Medical - Hospice Care (Assisted Living Facility)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5006	Administrative-Medical - Hospice Care (Hospice Inpatient Facility)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5005	Administrative-Medical - Hospice Care (Inpatient Hospital)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5008	Administrative-Medical - Hospice Care (Inpatient Psych Facility)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5007	Administrative-Medical - Hospice Care (Long Term Care Facility)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
Q5004	Administrative-Medical - Hospice Care (Skilled Nursing Facility)	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96413	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96415	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96416	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96417	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96440	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96446	Administrative-Medical - Inpatient	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96450	Injectable/Infusion	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96542	Injectable/Infusion	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy

Sources

Prior Authorization List for Blue Shield Medicare