Regence BlueCross BlueShield of Utah prior authorization, page 8
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 |
|---|---|---|
| L0633 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0634 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0636 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0637 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0638 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0639 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| L0640 | Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar | Commercial Pre-authorization List, Pg 1 Original policy |
| E0766 | Tumor Treatment Field Therapy | Commercial Pre-authorization List, Pg 1 Original policy |
| 81401 | Genetic Testing for Alzheimer's Disease | Commercial Pre-authorization List, Pg 1 Original policy |
| 81405 | Genetic Testing for Alzheimer's Disease | Commercial Pre-authorization List, Pg 1 Original policy |
| 81406 | Genetic Testing for Alzheimer's Disease | Commercial Pre-authorization List, Pg 1 Original policy |
| 81162 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81163 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81164 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81165 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81166 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81167 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81212 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81215 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81216 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81217 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81307 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81308 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81321 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81322 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81323 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81351 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81352 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81404 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81432 | Genetic Testing for Hereditary Breast, Ovarian, Pancreatic and Prostate Cancer and Li-Fraumeni Syndrome | Commercial Pre-authorization List, Pg 1 Original policy |
| 81201 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81202 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81203 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81210 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81288 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81292 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81293 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81294 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81295 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81296 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81297 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81298 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81299 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81300 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81317 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81318 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81319 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81435 | Genetic Testing for Lynch Syndrome and APC-associated and MUTYH-associated Polyposis Syndromes | Commercial Pre-authorization List, Pg 1 Original policy |
| 81225 | Cytochrome p450 and VKORC1 Genotyping for Treatment Selection and Dosing | Commercial Pre-authorization List, Pg 1 Original policy |
| 81227 | Cytochrome p450 and VKORC1 Genotyping for Treatment Selection and Dosing | Commercial Pre-authorization List, Pg 1 Original policy |