Blue Shield of California prior authorization, page 2

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
96549	Injectable/Infusion	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9123	Administrative-Medical - Nursing/Shift Care	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9124	Administrative-Medical - Nursing/Shift Care	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9975	Administrative-Medical - Solid Organ Transplant	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9560	Administrative-Pharmacy	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
00104	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
0889T	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
0891T	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
0892T	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
90867	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
90868	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
90869	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
90870	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96116	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96121	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96132	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96133	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96136	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96137	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96138	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96139	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
96146	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
G0137	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
G0410	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
G0411	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
G2000	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0009	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0010	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0011	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0012	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0013	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0014	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0015	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0017	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0018	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0019	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0031	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H0035	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
H2012	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S0201	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
S9480	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
T2048	Behavioral Health RadMD CarePro	Prior Authorization List for Blue Shield Medicare, Pg 1 Original policy
00170	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
0627T	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
0628T	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
0629T	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
0630T	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
0813T	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
11920	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy
11921	Medicare Medical Code List	Prior Authorization List for Blue Shield Medicare, Pg 2 Original policy

Sources

Prior Authorization List for Blue Shield Medicare