Regence BlueShield of Idaho 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
| Code | Description | Source |
|---|---|---|
| 57335 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 57426 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 58353 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 58356 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 58563 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| C1813 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| C2622 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| L8600 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 15830 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 15820 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 15821 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 15822 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 15823 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67900 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67901 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67902 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67903 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67904 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67906 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67908 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67909 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 67950 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21120 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21121 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21122 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21123 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 21209 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 11950 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 11951 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 11952 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 11954 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30400 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30410 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30420 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30430 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30435 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 30450 | Gender Affirming Interventions for Gender Dysphoria | Commercial Pre-authorization List, Pg 1 Original policy |
| 99183 | Hyperbaric Oxygen Therapy | Commercial Pre-authorization List, Pg 1 Original policy |
| G0277 | Hyperbaric Oxygen Therapy | Commercial Pre-authorization List, Pg 1 Original policy |
| 90875 | Neurofeedback | Commercial Pre-authorization List, Pg 1 Original policy |
| 90876 | Neurofeedback | Commercial Pre-authorization List, Pg 1 Original policy |
| 90901 | Neurofeedback | Commercial Pre-authorization List, Pg 1 Original policy |
| 38206 | Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow | Commercial Pre-authorization List, Pg 1 Original policy |
| 38232 | Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow | Commercial Pre-authorization List, Pg 1 Original policy |
| 38241 | Orthopedic Applications of Stem-Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow | Commercial Pre-authorization List, Pg 1 Original policy |
| 38205 | Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia | Commercial Pre-authorization List, Pg 1 Original policy |
| 38240 | Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia | Commercial Pre-authorization List, Pg 1 Original policy |
| 00640 | Pain management | Commercial Pre-authorization List, Pg 1 Original policy |
| 22510 | Pain management | Commercial Pre-authorization List, Pg 1 Original policy |
| 22511 | Pain management | Commercial Pre-authorization List, Pg 1 Original policy |