Regence BlueCross BlueShield of Oregon prior authorization, page 30
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 |
|---|---|---|
| 64597 | Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field Stimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 64598 | Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field Stimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 33340 | Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation | Commercial Pre-authorization List, Pg 1 Original policy |
| 55880 | Magnetic Resonance (MR) Guided Focused Ultrasound (MRgFUS), and High Intensity Focused Ultrasound (HIFU) Ablation, and Transurethral Ultrasound Ablation (TULSA) | Commercial Pre-authorization List, Pg 1 Original policy |
| 61715 | Magnetic Resonance (MR) Guided Focused Ultrasound (MRgFUS), and High Intensity Focused Ultrasound (HIFU) Ablation, and Transurethral Ultrasound Ablation (TULSA) | Commercial Pre-authorization List, Pg 1 Original policy |
| 19300 | Mastectomy as a Treatment of Gynecomastia | Commercial Pre-authorization List, Pg 1 Original policy |
| 32998 | Microwave Tumor Ablation | Commercial Pre-authorization List, Pg 1 Original policy |
| 50592 | Microwave Tumor Ablation | Commercial Pre-authorization List, Pg 1 Original policy |
| 64553 | Occipital Nerve Stimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 21085 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21110 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21150 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21151 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21154 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21155 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21159 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21160 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21198 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21206 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21210 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21215 | Orthognathic surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21740 | Pectus Excavatum and Carinatum Surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21742 | Pectus Excavatum and Carinatum Surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 21743 | Pectus Excavatum and Carinatum Surgery | Commercial Pre-authorization List, Pg 1 Original policy |
| 37238 | Percutaneous Angioplasty and Stenting of Veins | Commercial Pre-authorization List, Pg 1 Original policy |
| 37248 | Percutaneous Angioplasty and Stenting of Veins | Commercial Pre-authorization List, Pg 1 Original policy |
| C1823 | Phrenic Nerve Stimulation for Central Sleep Apnea | Commercial Pre-authorization List, Pg 1 Original policy |
| 20982 | Radiofrequency Ablation of Tumors (RFA) Other Than the Liver | Commercial Pre-authorization List, Pg 1 Original policy |
| 58580 | Radiofrequency Ablation of Tumors (RFA) Other Than the Liver | Commercial Pre-authorization List, Pg 1 Original policy |
| 58674 | Radiofrequency Ablation of Tumors (RFA) Other Than the Liver | Commercial Pre-authorization List, Pg 1 Original policy |
| 60660 | Radiofrequency Ablation of Tumors (RFA) Other Than the Liver | Commercial Pre-authorization List, Pg 1 Original policy |
| 60661 | Radiofrequency Ablation of Tumors (RFA) Other Than the Liver | Commercial Pre-authorization List, Pg 1 Original policy |
| 0338T | Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension | Commercial Pre-authorization List, Pg 1 Original policy |
| 0339T | Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension | Commercial Pre-authorization List, Pg 1 Original policy |
| 0935T | Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension | Commercial Pre-authorization List, Pg 1 Original policy |
| C1735 | Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension | Commercial Pre-authorization List, Pg 1 Original policy |
| C1736 | Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension | Commercial Pre-authorization List, Pg 1 Original policy |
| 19328 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 19330 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 19340 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 19342 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 19370 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 19371 | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants | Commercial Pre-authorization List, Pg 1 Original policy |
| 61889 | Responsive Neurostimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 61891 | Responsive Neurostimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 30120 | Rhinoplasty | Commercial Pre-authorization List, Pg 1 Original policy |
| 0786T | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Commercial Pre-authorization List, Pg 1 Original policy |
| 0787T | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Commercial Pre-authorization List, Pg 1 Original policy |
| 64561 | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Commercial Pre-authorization List, Pg 1 Original policy |
| 64581 | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction | Commercial Pre-authorization List, Pg 1 Original policy |