Regence BlueShield of Idaho prior authorization, page 31
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 |
|---|---|---|
| 27278 | Sacroiliac Joint Fusion | Commercial Pre-authorization List, Pg 1 Original policy |
| 27279 | Sacroiliac Joint Fusion | Commercial Pre-authorization List, Pg 1 Original policy |
| 27280 | Sacroiliac Joint Fusion | Commercial Pre-authorization List, Pg 1 Original policy |
| C1737 | Sacroiliac Joint Fusion | Commercial Pre-authorization List, Pg 1 Original policy |
| 0784T | Spinal Cord and Dorsal Root Ganglion Stimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 0785T | Spinal Cord and Dorsal Root Ganglion Stimulation | Commercial Pre-authorization List, Pg 1 Original policy |
| 0164T | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 0165T | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 0719T | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 22857 | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 22860 | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 22862 | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| 22865 | Spinal Surgery - Artificial Intervertebral Disc | Commercial Pre-authorization List, Pg 1 Original policy |
| G0563 | Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy | Commercial Pre-authorization List, Pg 1 Original policy |
| 10121 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 10140 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 10160 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 10180 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11042 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11044 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11402 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11403 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11404 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11406 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11420 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11422 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11423 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11424 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11426 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11440 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11441 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11443 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11446 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11450 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11470 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11601 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11603 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11606 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11626 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11750 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11770 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 11900 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12001 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12002 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12020 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12031 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12032 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12035 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 12037 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |
| 13132 | Surgical Site of Care - Hospital Outpatient | Commercial Pre-authorization List, Pg 1 Original policy |