Regence BlueCross BlueShield of Utah prior authorization, page 13
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 |
|---|---|---|
| 17999 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 19303 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 19316 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 19318 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 19325 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 19350 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21125 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21127 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21137 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21139 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21141 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21142 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21143 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21145 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21146 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21147 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21188 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21193 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21194 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21195 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21196 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21208 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21270 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53400 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53405 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53410 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53415 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53420 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53425 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 53430 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54125 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54400 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54401 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54405 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54520 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54660 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 54690 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 55175 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 55180 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 55970 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 55980 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 56625 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 56800 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 56805 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57106 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57110 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57291 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57292 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57295 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57296 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |