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Regence BlueCross BlueShield of Oregon prior authorization, page 14

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
CodeDescriptionSource
57335Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
57426Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
58353Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
58356Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
58563Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
C1813Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
C2622Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
L8600Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15830Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15820Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15821Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15822Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15823Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67900Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67901Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67902Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67903Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67904Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67906Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67908Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67909Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
67950Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
21120Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
21121Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
21122Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
21123Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
21209Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
11950Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
11951Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
11952Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
11954Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30400Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30410Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30420Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30430Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30435Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
30450Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
99183Hyperbaric Oxygen TherapyCommercial Pre-authorization List, Pg 1 Original policy
G0277Hyperbaric Oxygen TherapyCommercial Pre-authorization List, Pg 1 Original policy
90875NeurofeedbackCommercial Pre-authorization List, Pg 1 Original policy
90876NeurofeedbackCommercial Pre-authorization List, Pg 1 Original policy
90901NeurofeedbackCommercial Pre-authorization List, Pg 1 Original policy
38206Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone MarrowCommercial Pre-authorization List, Pg 1 Original policy
38232Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone MarrowCommercial Pre-authorization List, Pg 1 Original policy
38241Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone MarrowCommercial Pre-authorization List, Pg 1 Original policy
38205Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to IschemiaCommercial Pre-authorization List, Pg 1 Original policy
38240Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to IschemiaCommercial Pre-authorization List, Pg 1 Original policy
00640Pain managementCommercial Pre-authorization List, Pg 1 Original policy
22510Pain managementCommercial Pre-authorization List, Pg 1 Original policy
22511Pain managementCommercial Pre-authorization List, Pg 1 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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