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Regence BlueShield of Idaho prior authorization, page 12

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
61798Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
61799Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
61800Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
63620Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
63621Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77301Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77338Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77371Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77372Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77373Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77432Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77435Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77520Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77522Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77523Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
77525Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
G0339Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
G0340Charged-Particle (Proton) RadiotherapyCommercial Pre-authorization List, Pg 1 Original policy
43206Confocal Laser EndomicroscopyCommercial Pre-authorization List, Pg 1 Original policy
43252Confocal Laser EndomicroscopyCommercial Pre-authorization List, Pg 1 Original policy
88375Confocal Laser EndomicroscopyCommercial Pre-authorization List, Pg 1 Original policy
98978Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
A9291Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
A9292Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
A9294Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
E1905Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
G0552Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
G0553Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
G0554Digital Therapeutic ProductsCommercial Pre-authorization List, Pg 1 Original policy
31626Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
31627Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
C7509Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
C7510Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
C7511Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
C7567Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
C8005Electromagnetic Navigation BronchoscopyCommercial Pre-authorization List, Pg 1 Original policy
11920Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
11921Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15769Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15771Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15772Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15773Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15774Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15775Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15776Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15825Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15828Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15829Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
15839Gender Affirming Interventions for Gender DysphoriaCommercial Pre-authorization List, Pg 1 Original policy
17380Gender Affirming Interventions for Gender DysphoriaCommercial 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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