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Regence BlueShield of Idaho 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

Prior authorization codes
CodeDescriptionSource
64597Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field StimulationCommercial Pre-authorization List, Pg 1 Original policy
64598Implantable Peripheral Nerve Stimulation and Peripheral Subcutaneous Field StimulationCommercial Pre-authorization List, Pg 1 Original policy
33340Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial FibrillationCommercial Pre-authorization List, Pg 1 Original policy
55880Magnetic 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
61715Magnetic 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
19300Mastectomy as a Treatment of GynecomastiaCommercial Pre-authorization List, Pg 1 Original policy
32998Microwave Tumor AblationCommercial Pre-authorization List, Pg 1 Original policy
50592Microwave Tumor AblationCommercial Pre-authorization List, Pg 1 Original policy
64553Occipital Nerve StimulationCommercial Pre-authorization List, Pg 1 Original policy
21085Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21110Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21150Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21151Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21154Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21155Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21159Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21160Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21198Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21206Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21210Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21215Orthognathic surgeryCommercial Pre-authorization List, Pg 1 Original policy
21740Pectus Excavatum and Carinatum SurgeryCommercial Pre-authorization List, Pg 1 Original policy
21742Pectus Excavatum and Carinatum SurgeryCommercial Pre-authorization List, Pg 1 Original policy
21743Pectus Excavatum and Carinatum SurgeryCommercial Pre-authorization List, Pg 1 Original policy
37238Percutaneous Angioplasty and Stenting of VeinsCommercial Pre-authorization List, Pg 1 Original policy
37248Percutaneous Angioplasty and Stenting of VeinsCommercial Pre-authorization List, Pg 1 Original policy
C1823Phrenic Nerve Stimulation for Central Sleep ApneaCommercial Pre-authorization List, Pg 1 Original policy
20982Radiofrequency Ablation of Tumors (RFA) Other Than the LiverCommercial Pre-authorization List, Pg 1 Original policy
58580Radiofrequency Ablation of Tumors (RFA) Other Than the LiverCommercial Pre-authorization List, Pg 1 Original policy
58674Radiofrequency Ablation of Tumors (RFA) Other Than the LiverCommercial Pre-authorization List, Pg 1 Original policy
60660Radiofrequency Ablation of Tumors (RFA) Other Than the LiverCommercial Pre-authorization List, Pg 1 Original policy
60661Radiofrequency Ablation of Tumors (RFA) Other Than the LiverCommercial Pre-authorization List, Pg 1 Original policy
0338TRadiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled HypertensionCommercial Pre-authorization List, Pg 1 Original policy
0339TRadiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled HypertensionCommercial Pre-authorization List, Pg 1 Original policy
0935TRadiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled HypertensionCommercial Pre-authorization List, Pg 1 Original policy
C1735Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled HypertensionCommercial Pre-authorization List, Pg 1 Original policy
C1736Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled HypertensionCommercial Pre-authorization List, Pg 1 Original policy
19328Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
19330Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
19340Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
19342Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
19370Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
19371Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsCommercial Pre-authorization List, Pg 1 Original policy
61889Responsive NeurostimulationCommercial Pre-authorization List, Pg 1 Original policy
61891Responsive NeurostimulationCommercial Pre-authorization List, Pg 1 Original policy
30120RhinoplastyCommercial Pre-authorization List, Pg 1 Original policy
0786TSacral Nerve Neuromodulation (Stimulation) for Pelvic Floor DysfunctionCommercial Pre-authorization List, Pg 1 Original policy
0787TSacral Nerve Neuromodulation (Stimulation) for Pelvic Floor DysfunctionCommercial Pre-authorization List, Pg 1 Original policy
64561Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor DysfunctionCommercial Pre-authorization List, Pg 1 Original policy
64581Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor DysfunctionCommercial 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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