Single source preauthorization list
This information is not a guarantee of payment.
Benefits are subject to limitations in a member’s Certificate of Coverage and the member’s eligibility status.
The information being provided is based on information currently available in Capital BlueCross' files.
Payment or processing of actual claims is subject to a determination regarding the member’s benefits and eligibility at the time of processing and a determination that the services are medically necessary and appropriate. Other factors, including, but not limited to, outstanding or in-process claims, may affect actual totals. Information may change due to coverage alterations or cancellation. All information on this computer system is proprietary and confidential to Capital BlueCross and is to be used only for its intended purposes.
Do not disclose
- CPT and revenue code descriptions are subject to copyright and therefore not included on the external single source preauthorization code list. Please refer to the web or published manuals for a description of the service.
- Preauthorization is required for the following list of items that are not necessarily listed separately by code: All inpatient admissions and observation care over 48 hours; services/items that are considered by Capital BlueCross medical policy to be experimental/investigational and possibly cosmetic.
- Preauthorization is required for non-routine maternity admissions, including preterm labor, maternity complications, and newborns requiring continued hospitalization after the mother is discharged.
- Effective 1/1/2020 DME/Orthotics/Prosthetic items requiring preauthorization will be individually listed below on the single source preauthorization code list. If the service is found, preauthorization is required on rentals and/or purchases. If not found below, then the DME service does not require preauthorization.
- Preauthorization does not generally apply to services/items that are specifically excluded from coverage under the member’s Certificate of Coverage. Therefore, these items may not appear on the preauthorization list.
- All services that are considered investigational/experimental or possibly cosmetic require documentation from the member’s medical record to ensure the item/service is medically necessary. Certain services may also require submission of photographs and are noted below.
- Please refer to Capital BlueCross medical policy (or its delegated vendor) for medical necessity information.
- Refer to medical policy 3.015 entitled "office-based procedures performed in a facility" which is available on the Capital BlueCross medical policy website for a list of services that require preauthorization when performed in a facility. These procedures can be safely performed in an office setting for most patients. Individual consideration can be given in the form of preauthorization for unique member conditions as outlined in the medical policy.
- Administrative services only (ASO)/ self-funded groups: Please note that some self-funded employer groups may customize their plans with different benefits and preauthorization requirements. The provider can check authorization requirements at the service code level via the authorization portal.
- Subject to the exceptions listed in the general preauthorization overview, codes requiring preauthorization are listed by code below.
| Code | HCPCS and dental code description | Preauthorization category | Type of care | Comments | Commercial | BlueJourney |
|---|---|---|---|---|---|---|
|
0901 |
|
Select outpatient behavioral health services |
Behavioral health service |
Facility revenue code requires preauthorzation |
Yes |
Yes |
|
0001U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0003U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0005U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0009M |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0009U |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
0012U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0013U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0014U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0016U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0017U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0018U |
|
Investigational and experimental procedures |
Diagnostic services : Genetic testing |
For BlueJourney covered if medically necessary |
Yes |
Yes |
|
0019U |
|
Investigational and experimental procedures |
Lab/Genetic testing |
For BlueJourney covered if medically necessary |
Yes |
Yes |
|
0021U |
|
Investigational and experimental procedures |
Lab/Genetic testing |
|
Yes |
Yes |
|
0023U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0026U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0027U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0029U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0034U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0035U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0037U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0040U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0042T |
|
Diagnostic services: CT scans |
X-ray/Imaging - Cat scan |
This service is preauthorized through National Imaging Associates (NIA). Traditional Products do not require preauthorization |
Yes |
Yes |
|
0046U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0047U |
|
Diagnostic services: Genetic testing |
Investigational lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
0049U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0078U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0084U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0129U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0130U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0131U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0132U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0133U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0134U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0135U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0136U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0137U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
No |
Yes |
|
0138U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0152U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0153U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0154U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0155U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0157U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
No |
|
0158U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
No |
|
0159U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
No |
|
0160U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
No |
|
0161U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
No |
|
0162U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0163T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0165T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0169U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0171U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0172U |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0173U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0177U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0180U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0181U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0182U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0183U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0184U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0185U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0186U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0187U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0188U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0189U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0190U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0191T |
|
Investigational and experimental procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
0191U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0192U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0193U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0194U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0195U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0196U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0197U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0198U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0199U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0200T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0200U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0201T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0201U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0202T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0204U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0208U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0212U |
|
Diagnostic services: MRI |
Diagnostic services: MRI |
|
Yes |
Yes |
|
0213U |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
0219T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0220T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0221T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0222T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0230U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0231U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0232U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
If it does not meet the medcially necessary critreia on policy then invalid |
Yes |
Yes |
|
0233U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0234U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
If it does not meet the criteria on 2.326 |
Yes |
Yes |
|
0235U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0236U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
0237U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0238U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
If it does not meet criteria on policy then invalid |
Yes |
No |
|
0239U |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
0253T |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
0274T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0275T |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
0345T |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
No |
|
0362T |
|
Investigational and experimental procedures |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
0373T |
|
Investigational and experimental procedures |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
0376T |
|
Outpatient surgery for select procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
0394T |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
0395T |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
0402T |
|
New to market service |
New Technology |
|
Yes |
Yes |
|
0413 |
|
Therapy services: Hyperbaric oxygen |
Hyperbaric oxygen |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0420 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0421 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0422 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0423 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0424 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0429 |
|
Therapy services: Physical therapy |
Physical therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0430 |
|
Investigational and experimental procedures |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0431 |
|
Therapy services: Hyperbaric oxygen |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0432 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0433 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0434 |
|
Therapy services: Hyperbaric oxygen |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0439 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0441T |
|
New to market service |
New Technology
|
|
Yes |
Yes |
|
0449T |
|
Investigational and experimental procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
0450T |
|
Investigational and experimental procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
0466T |
|
Outpatient surgery for select procedures |
Surgery - Chest |
|
Yes |
No |
|
0467T |
|
Outpatient surgery for select procedures |
Surgery - Chest |
|
Yes |
No |
|
0474T |
|
Investigational and experimental procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
0483T |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
No |
|
0524T |
|
Reconstructive or cosmetic services: Varicose veins |
Varicose vein procedure |
|
Yes |
Yes |
|
0570 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0571 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0572 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0579 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0580 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0581 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0582 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0583 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0584T |
|
Transplant surgeries |
Organ/Tissue transplant - Islet cell (pancreas) |
|
Yes |
No |
|
0585T |
|
Transplant surgeries |
Organ/Tissue transplant - Islet cell (pancreas) |
|
Yes |
No |
|
0586T |
|
Transplant surgeries |
Organ/Tissue transplant - Islet cell (pancreas) |
|
Yes |
No |
|
0589 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0590 |
|
Other services: Home health care |
Home health care |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0624 |
|
Investigational and experimental procedures |
Investigational Supply |
Facility revenue code requires preauthorization. |
Yes |
Yes |
|
0905 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
0906 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
0912 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
0913 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
10040 |
|
Reconstructive or cosmetic services: Acne surgery |
Surgery - skin procedure |
|
Yes |
Yes |
|
11000 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11001 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11042 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11043 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11044 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11750 |
|
Office surgical procedures |
Nail procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11765 |
|
Office surgical procedures |
Nail procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
11920 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
11921 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
11950 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
|
Yes |
Yes |
|
11951 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
|
Yes |
Yes |
|
11952 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
|
Yes |
Yes |
|
11954 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
|
Yes |
Yes |
|
11960 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
|
Yes |
Yes |
|
11970 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
11971 |
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
12001 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
12011 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
15150 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15155 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15271 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15273 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15275 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15277 |
|
Other services: wound care products |
Wound care |
|
Yes |
Yes |
|
15771 |
|
Reconstructive or cosmetic services: Breast procedures |
Reconstructive or cosmetic services: Augmentation and grafting |
|
Yes |
Yes |
|
15775 |
|
Reconstructive or cosmetic services: Hair transplant |
Hair transplant |
|
Yes |
Yes |
|
15776 |
|
Reconstructive or cosmetic services: Hair transplant |
Hair transplant |
|
Yes |
Yes |
|
15780 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15781 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15782 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15783 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15786 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15788 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15789 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15792 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15793 |
|
Reconstructive or cosmetic services: Dermabrasion |
Skin procedure |
|
Yes |
Yes |
|
15820 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
15821 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
15822 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
No |
|
15823 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
No |
|
15824 |
|
Reconstructive or cosmetic services: Rhytidectomy |
Skin procedure |
|
Yes |
Yes |
|
15825 |
|
Reconstructive or cosmetic services: Rhytidectomy |
Skin procedure |
|
Yes |
Yes |
|
15826 |
|
Reconstructive or cosmetic services: Rhytidectomy |
Skin procedure |
|
Yes |
Yes |
|
15828 |
|
Reconstructive or cosmetic services: Rhytidectomy |
Skin procedure |
|
Yes |
Yes |
|
15829 |
|
Reconstructive or cosmetic services: Rhytidectomy |
Skin procedure |
|
Yes |
Yes |
|
15830 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
No |
|
15832 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15833 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15834 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15835 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15836 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15837 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15838 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15839 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15876 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15877 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15878 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
15879 |
|
Reconstructive or cosmetic services: Excision /Lipectomy |
Skin procedure |
|
Yes |
Yes |
|
16000 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
16020 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
16025 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
16030 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
16035 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
16036 |
|
Office surgical procedures |
Skin procedure |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
17106 |
|
Other services: Laser treatment |
Skin procedure |
|
Yes |
Yes |
|
17107 |
|
Other services: Laser treatment |
Skin procedure |
|
Yes |
Yes |
|
17108 |
|
Other services: Laser treatment |
Skin procedure |
|
Yes |
Yes |
|
17360 |
|
Reconstructive or cosmetic services: Acne surgery |
Skin procedure |
|
Yes |
Yes |
|
17380 |
|
Reconstructive or cosmetic services: Acne surgery |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
19296 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
19297 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
19298 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
19300 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19316 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19318 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19325 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19328 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19330 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19340 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19342 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19350 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19355 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19357 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19361 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19364 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19367 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19368 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19369 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19370 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19371 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19380 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
19396 |
|
Reconstructive or cosmetic services: Breast procedures |
Surgery - Breast |
Preauthorization not required for treatment of cancer. |
Yes |
Yes |
|
20550 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20551 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20552 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20553 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20600 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20605 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20610 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20612 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
20974 |
|
Investigational and experimental procedures |
Bone stimulator |
|
Yes |
Yes |
|
20975 |
|
Investigational and experimental procedures |
Bone stimulator |
|
Yes |
Yes |
|
20979 |
|
Investigational and experimental procedures |
Bone stimulator |
|
Yes |
Yes |
|
20982 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
20983 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
21073 |
|
Investigational and experimental procedures |
Investigational TMJ treatment |
|
Yes |
Yes |
|
21116 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
21120 |
|
Other services: Augmentation and Grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21121 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21122 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21123 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21125 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21127 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21137 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21138 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21139 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21141 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21142 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
| 21143
|
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21145 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21146 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21147 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21150 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21151 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21154 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21155 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21159 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21160 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21172 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21175 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21179 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21180 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21181 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21182 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21183 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21184 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21188 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21193 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21194 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21195 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21196 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21198 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21199 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21206 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21208 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21209 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21210 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21215 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21230 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21235 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21240 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21242 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21243 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21244 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21245 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21246 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21247 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21248 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21249 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21255 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21256 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
| 21260
|
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21261 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21263 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21267 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21268 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21270 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
| 21275
|
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21280 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Eye |
|
Yes |
Yes |
|
21282 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Eye |
|
Yes |
Yes |
|
21431 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21432 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21433 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21435 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21436 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
21740 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Chest |
|
Yes |
Yes |
|
21742 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Chest |
|
Yes |
Yes |
|
21743 |
|
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Chest |
|
Yes |
Yes |
|
22220 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22222 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22224 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22226 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22510 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22511 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22512 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22513 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22514 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22515 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22532 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22533 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22534 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22548 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22551 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22552 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22554 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22556 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22558 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22585 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22586 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22590 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22595 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22600 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22610 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22612 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22614 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22630 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22632 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22633 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22634 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22800 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22802 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22804 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22808 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22810 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22812 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22818 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22819 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22830 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22849 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22856 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22857 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22858 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22861 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22862 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22864 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22865 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22867 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22868 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22869 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22870 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
22899 |
|
Surgery for select procedures |
Musculoskeletal Procedures |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23120 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point. |
Yes |
Yes |
|
23125 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23130 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23190 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23195 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23333 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23334 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23335 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23395 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23397 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23400 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23405 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23406 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23410 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23412 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23415 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23420 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23440 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23450 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23455 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23460 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23462 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23465 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23466 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23470 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23472 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23473 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23474 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23616 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23800 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
23802 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27033 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27090 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27091 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27120 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27122 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27125 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27130 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27132 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27134 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27137 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27138 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27146 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27147 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27151 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27156 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27158 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27161 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27236 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27279 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27280 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27284 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27286 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27299 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27403 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27405 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27407 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27409 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27412 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27415 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27416 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27418 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27420 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27422 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27424 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27425 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27427 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27428 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27429 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27437 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27438 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27440 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27441 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27442 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27443 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27445 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27446 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27447 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27486 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27487 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27488 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27570 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
27580 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
28446 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29827 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29850 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29851 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29855 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29856 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29860 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29861 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29862 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29863 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29866 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29867 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29868 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29870 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29871 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29873 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29874 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29875 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29876 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29877 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29879 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29880 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29881 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29882 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29883 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29884 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29885 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29886 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29887 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29888 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29889 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29914 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29915 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29916 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
29999 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point. |
Yes |
Yes |
|
30400 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
30410 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
No |
|
30420 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
No |
|
30430 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
No |
|
30435 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
No |
|
30450 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
No |
|
30460 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
30462 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
30520 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
30620 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
31295 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
11/16/2020 - Changing from non-covered to preauthorization . MP 1.119 Balloon Ostial Dilation for the Treatment of Chronic Rhinosinusitis Code removed from Preauth-NCV-Medical Policy 4.002 effective 1/1/2018 |
Yes |
Yes |
|
31296 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
11/16/2020 - Changing from non-covered to preauthorization . MP 1.119 Balloon Ostial Dilation for the Treatment of Chronic Rhinosinusitis Code removed from Preauth-NCV-Medical Policy 4.002 effective 1/1/2018 |
Yes |
Yes |
|
31297 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
11/16/2020 - Changing from non-covered to preauthorization. MP 1.119 Balloon Ostial Dilation for the Treatment of Chronic Rhinosinusitis Code removed from Preauth-NCV-Medical Policy 4.002 effective 1/1/2018 |
Yes |
Yes |
|
31298 |
|
Reconstructive or cosmetic services: repair nasal/septal defects |
Surgery - nose/sinuses |
|
Yes |
Yes |
|
31574 |
|
Reconstructive |
Injection procedure |
|
Yes |
Yes |
|
31591 |
|
Investigational and experimental procedures |
Reconstructive or cosmetic services |
|
Yes |
Yes |
|
31660 |
|
Surgery for select procedures |
Surgery - Lung |
|
Yes |
Yes |
|
31661 |
|
Surgery for select procedures |
Surgery - Lung |
|
Yes |
Yes |
|
32850 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32851 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32852 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32853 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32854 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32855 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32856 |
|
Transplant surgeries |
Organ/Tissue transplant - Lung |
|
Yes |
Yes |
|
32998 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
33270 |
|
Investigational and experimental procedures |
Investigational heart procedures |
|
Yes |
Yes |
|
33271 |
|
Investigational and experimental procedures |
Investigational heart procedures |
|
Yes |
Yes |
|
33273 |
|
Investigational and experimental procedures |
Investigational heart procedures |
|
Yes |
Yes |
|
33285 |
|
Outpatient surgery: Elective cardiac procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33361 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33362 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33363 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33364 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33365 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33366 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
Yes |
|
33418 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
No |
|
33419 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
No |
|
33477 |
|
Outpatient surgery for select procedures |
Surgery - Heart valve |
|
Yes |
No |
|
33622 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33927 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart |
|
Yes |
No |
|
33928 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart |
|
Yes |
No |
|
33930 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart/Lung |
|
Yes |
Yes |
|
33933 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart/Lung |
|
Yes |
Yes |
|
33935 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart/Lung |
|
Yes |
Yes |
|
33940 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart |
|
Yes |
Yes |
|
33944 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart |
|
Yes |
Yes |
|
33945 |
|
Transplant surgeries |
Organ/Tissue transplant - Heart |
|
Yes |
Yes |
|
33975 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33976 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33977 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33978 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33979 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33980 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33981 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33982 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
33983 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34501 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34502 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34510 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34520 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34530 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34701 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34702 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34703 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34704 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34705 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34706 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34707 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
34708 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
36465 |
|
Reconstructive or cosmetic services: Varicose veins |
Varicose vein procedure |
|
Yes |
Yes |
|
36466 |
|
Reconstructive or cosmetic services: Varicose veins |
Varicose vein procedure |
|
Yes |
Yes |
|
36468 |
|
Reconstructive or cosmetic services: Varicose veins |
Vein procedures |
|
Yes |
No |
|
36470 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
36471 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
36475 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
36478 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
36482 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
37216 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
No |
Yes |
|
37241 |
|
Outpatient surgery for select procedures |
Surgery - Heart/Blood vessel |
|
Yes |
Yes |
|
37500 |
|
Reconstructive or cosmetic services: Varicose veins |
Vein procedures |
|
Yes |
Yes |
|
37700 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37718 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37722 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37735 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37760 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37761 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37765 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37766 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37780 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
37785 |
|
Reconstructive or cosmetic services: Varicose veins |
Surgery - Varicose vein |
|
Yes |
Yes |
|
38205 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38206 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38207 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38208 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38209 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38210 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38211 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38212 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38213 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38214 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38215 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38230 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38232 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38240 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38241 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38242 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
38243 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
41822 |
|
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
41823 |
|
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
41825 |
|
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
41826 |
|
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
41850 |
|
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
43229 |
|
Outpatient surgery for select procedures |
Gastrointestinal procedure |
Requires preauthorization only for treatment of Barrett’s esophagus with dysplasia |
Yes |
No |
|
43270 |
|
Outpatient surgery for select procedures |
Gastrointestinal procedure |
Requires preauthorization only for treatment of Barrett’s esophagus with dysplasia |
Yes |
No |
|
43644 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43645 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43647 |
|
Invesitgational and experimental procedures |
Invesitgational and experimental procedures |
|
Yes |
Yes |
|
43648 |
|
Invesitgational and experimental procedures |
Invesitgational and experimental procedures |
|
Yes |
Yes |
|
43659 |
|
Outpatient surgery for select procedures |
Surgery - Stomach and intestines |
|
Yes |
Yes |
|
43770 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43771 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43772 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43773 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43774 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43775 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43842 |
|
Investigational and experimental procedures |
Investigational Weight Loss Surgery |
|
Yes |
Yes |
|
43843 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43845 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43846 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43847 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43848 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43881 |
|
Invesitgational and experimental procedures |
Invesitgational and experimental procedures |
|
Yes |
Yes |
|
43882 |
|
Invesitgational and experimental procedures |
Invesitgational and experimental procedures |
|
Yes |
Yes |
|
43886 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43887 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
43888 |
|
Outpatient services: Bariatric surgery |
Surgery - Weight loss |
|
Yes |
Yes |
|
44132 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44133 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44135 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44136 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44715 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44720 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
44721 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
45300 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45303 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45305 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45307 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45308 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45309 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45315 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45317 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45320 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
45321 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
46230 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
46320 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
46924 |
|
Office surgical procedures |
Gastrointestinal procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
47133 |
|
Transplant surgeries |
Organ/Tissue transplant - Intestine |
|
Yes |
Yes |
|
47135 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47140 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47141 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47142 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47143 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47144 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47145 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47146 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47147 |
|
Transplant surgeries |
Organ/Tissue transplant - Liver |
|
Yes |
Yes |
|
47370 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
47380 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
47382 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
48160 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
No |
|
48550 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
Yes |
|
48551 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
Yes |
|
48552 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
Yes |
|
48554 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
Yes |
|
48556 |
|
Transplant surgeries |
Organ/Tissue transplant - Pancreas |
|
Yes |
Yes |
|
50300 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50320 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50323 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50325 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50327 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50328 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50329 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50340 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50360 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50365 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50380 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50542 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
50547 |
|
Transplant surgeries |
Organ/Tissue transplant - Kidney |
|
Yes |
Yes |
|
50592 |
|
Outpatient surgery for select procedures |
Tumor Ablations |
|
Yes |
Yes |
|
52441 |
|
Investigational and experimental procedures |
Investigational bladder procedure |
|
Yes |
Yes |
|
52442 |
|
Investigational and experimental procedures |
Investigational bladder procedure |
|
Yes |
Yes |
|
54065 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
55250 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
56820 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
56821 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57420 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57421 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57452 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57454 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57455 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
57456 |
|
Office surgical procedures |
Genital/Reproductive procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
61630 |
|
Investigational and experimental procedures |
Investigational heart procedures |
Non covered for commercial product |
No |
Yes |
|
61863 |
|
Outpatient surgery for select procedures |
Surgery - Head/Face |
|
Yes |
Yes |
|
61867 |
|
Outpatient surgery for select procedures |
Surgery - Head/Face |
|
Yes |
Yes |
|
61880 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
61885 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
No |
Yes |
|
61886 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
No |
Yes |
|
61888 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
No |
Yes |
|
62287 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63001 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63003 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63005 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63011 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63012 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63015 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63016 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63017 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63020 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63030 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63035 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63040 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63042 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63043 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63044 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63045 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63046 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63047 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63048 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63050 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63051 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63055 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63056 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63057 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63064 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63066 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63075 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63076 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63077 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63078 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63081 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63082 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63085 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63086 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63087 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63088 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63090 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63091 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63101 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63102 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63103 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63170 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63172 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63173 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63185 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63190 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63191 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63194 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63195 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63196 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63197 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63198 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63199 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63200 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63250 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63251 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63252 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63265 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63266 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63267 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63268 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63270 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63271 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63272 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63273 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63275 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63276 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63277 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63278 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63280 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63281 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63282 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63283 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63285 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63286 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63287 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63290 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63295 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63300 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63301 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63302 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63303 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63304 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63305 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63306 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63307 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
63308 |
|
Surgery for select procedures |
Surgery - Musculoskeletal |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
64420 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64421 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64450 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64451 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64454 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64553 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64555 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64561 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64566 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64568 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64569 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64570 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64575 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64580 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64581 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64585 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64590 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64595 |
|
Outpatient surgery for select procedures |
Nerve stimulator |
|
Yes |
Yes |
|
64620 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64624 |
|
Office surgical procedures |
Office surgical procedures |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
64633 |
|
Investigational and experimental procedures |
Investigational Nerve Procedure |
|
Yes |
Yes |
|
64635 |
|
Outpatient surgery for select procedures |
Nerve Procedures |
|
Yes |
Yes |
|
64640 |
|
Office surgical procedures |
Injection procedure |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
65756 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
65781 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
65782 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
65785 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
66179 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
66180 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
66183 |
|
Outpatient surgery for select procedures |
Surgery - Eye |
|
Yes |
Yes |
|
66184 |
|
Investigational and experimental procedures |
Investigational eye procedures |
|
Yes |
Yes |
|
67800 |
|
Office surgical procedures |
Surgery - Eyelid |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
67801 |
|
Office surgical procedures |
Surgery - Eyelid |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
67805 |
|
Office surgical procedures |
Surgery - Eyelid |
Requires preauthorization only when performed in a facility. |
Yes |
Yes |
|
67900 |
|
Reconstructive or cosmetic services: Ptosis repair
|
Surgery - Eyelid |
|
Yes |
Yes |
|
67901 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67902 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67903 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67904 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67906 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67908 |
|
Reconstructive or cosmetic services: Blepharoplasty |
Surgery - Eyelid |
|
Yes |
Yes |
|
67909 |
|
Reconstructive or cosmetic services: Ptosis repair
|
Surgery - Eyelid |
|
Yes |
Yes |
|
67911 |
|
Reconstructive or cosmetic services: Ptosis repair
|
Surgery - Eyelid |
|
Yes |
Yes |
|
68371 |
|
Transplant surgeries |
Organ/Tissue transplant - Conjunctiva (eye)
|
|
Yes |
Yes |
|
69300 |
|
Reconstructive or cosmetic services: Otoplasty |
Surgery - Head/Face |
|
Yes |
Yes |
|
69710 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
No |
|
69711 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
69714 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
69715 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
69717 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
69718 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
69930 |
|
Outpatient surgery for select procedures |
Hearing testing and treatment |
|
Yes |
Yes |
|
70336 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70450 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70460 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70470 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70480 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70481 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70482 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70486 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70487 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70488 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70490 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70491 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70492 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70496 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70498 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70540 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70542 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70543 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70544 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70545 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70546 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70547 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70548 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70549 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70551 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70552 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70553 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70554 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
70555 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
71250 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
71260 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
71270 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
71271 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This services is preauthorized through National Imaging Associates (NIA). Traditional Producats do not require Preauth |
Yes |
No |
|
71275 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
71550 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
71551 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
71552 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
71555 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72125 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72126 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72127 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72128 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72129 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72130 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72131 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72132 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72133 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72141 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72142 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72146 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72147 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72148 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72149 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72156 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72157 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72158 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72159 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72191 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72192 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72193 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72194 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72195 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72196 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72197 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
72198 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73200 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73201 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73202 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73206 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73218 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73219 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73220 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73221 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73222 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73223 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73225 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73700 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73701 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73702 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73706 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73718 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73719 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73720 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73721 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73722 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73723 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
73725 |
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74150 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74160 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74170 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74174 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74175 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74176 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74177 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74178 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74181 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74182 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74183 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74185 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74261 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74262 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74263 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
No |
|
74712 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
74713 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75557 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75559 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75561 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75563 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75565 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75571 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75572 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75573 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
75635 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
76380 |
|
Diagnostic services: CT scans |
X-ray/Imaging - cat scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
76390 |
|
Diagnostic services: SPECT |
Nuclear medicine testing - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
77014 |
|
Therapy services: Radiation therapy , IGRT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
77046 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
77047 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
77048 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
77049 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
77084 |
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
77280 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77285 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77290 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77295 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77300 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77301 |
|
Reconstructive or cosmetic services: Breast procedures |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77306 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77307 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77316 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77317 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77318 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77321 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77331 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77332 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77333 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77334 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77336 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77338 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77370 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77371 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77372 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77373 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77385 |
|
Therapy services: Radiation therapy , IMRT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77386 |
|
Therapy services: Radiation therapy , IMRT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77387 |
|
Therapy services: Radiation therapy , IGRT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77399 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77401 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77402 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77407 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77412 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77417 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77423 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77424 |
|
Therapy services: Radiation therapy ,IORT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77425 |
|
Therapy services: Radiation therapy ,IORT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77427 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77431 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77432 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77435 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77469 |
|
Therapy services: Radiation therapy ,IORT |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77470 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77499 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77520 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77522 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77523 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77525 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77600 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77605 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77610 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77615 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77620 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77761 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77762 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77763 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77767 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77768 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77770 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77771 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77772 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77778 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77789 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77790 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
77799 |
|
Therapy services: Radiation therapy |
Radiation therapy |
This service is preauthorized through National Imaging Associates (NIA). |
Yes |
Yes |
|
78429 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78430 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78431 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78432 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78433 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78434 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78451 |
|
Diagnostic services: SPECT |
X-Ray/Imaging -SPECT |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78452 |
|
Diagnostic services: SPECT |
X-Ray/Imaging -SPECT |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78453 |
|
Diagnostic services: Cardiac Nuclear Medicine Studies |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78454 |
|
Diagnostic services: Cardiac Nuclear Medicine Studies |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78459 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78466 |
|
Diagnostic services: Cardiac Nuclear Medicine Studies |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78468 |
|
Diagnostic services: Cardiac Nuclear Medicine Studies |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78469 |
|
Outpatient surgery: Elective cardiac procedures |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78472 |
|
Diagnostic services: MUGA |
Nuclear medicine testing - heart |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78473 |
|
Diagnostic services: MUGA |
Nuclear medicine testing - heart |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78481 |
|
Outpatient surgery: Elective cardiac procedures |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78483 |
|
Outpatient surgery: Elective cardiac procedures |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78491 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78492 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78494 |
|
Diagnostic services: MUGA |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78496 |
|
Diagnostic services: MUGA |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78499 |
|
Diagnostic services: Cardiac Nuclear Medicine Studies |
X-Ray/Imaging - Heart studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78608 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78609 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78803 |
|
Diagnostic services: |
X-Ray/Imaging -SPECT
|
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78811 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78812 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
78813 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78814 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78815 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
78816 |
|
Diagnostic services: PET scans |
X-Ray/Imaging - PET scan |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
81105 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81106 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81107 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81108 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81109 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81110 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81111 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81112 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81120 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81121 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81161 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81162 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81163 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81164 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81165 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81166 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81167 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81168 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81170 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81171 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81172 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81173 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81174 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81175 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81176 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81177 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81178 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81179 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81180 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81181 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81182 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81183 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81184 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81185 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81186 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81187 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81188 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81189 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81190 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81191 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81192 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81193 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81194 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81200 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81201 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81202 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81203 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81204 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81205 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81206 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81207 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81208 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81209 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81210 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81212 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81215 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81216 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81217 |
|
Diagnostic services: Genetic testing |
Diagnostic services: Genetic testing |
|
Yes |
Yes |
|
81218 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81219 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81220 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81221 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81222 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81223 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81224 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81225 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81226 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81228 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81229 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81230 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81231 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81232 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81233 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81234 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81235 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81236 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81237 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81238 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81239 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81240 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81241 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81242 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81243 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81244 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81245 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81246 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81250 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81251 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81252 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81253 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81254 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81255 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81256 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81257 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81258 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81259 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81260 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81261 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81262 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81263 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81264 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81265 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81266 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81269 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81270 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81271 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81272 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81273 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81274 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81275 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81276 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81277 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81278 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81279 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81283 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81284 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81285 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81286 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81287 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81288 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81289 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81290 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81292 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81293 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81294 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81295 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81296 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81297 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81298 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81299 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81300 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81301 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81302 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81303 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81304 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81305 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81306 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81307 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81308 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81309 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81310 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81311 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81312 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81313 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81314 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81315 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81316 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81317 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81318 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81319 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81320 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81321 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81322 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81323 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81324 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81325 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81326 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81327 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81328 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81329 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81330 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81331 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81332 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81333 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81334 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81335 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81336 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81337 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81338 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81339 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81340 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81341 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81342 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81343 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81344 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81345 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81346 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81347 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81348 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81350 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81351 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81352 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81353 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81357 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81360 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81361 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81362 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81363 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81364 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81400 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81401 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81402 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81403 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81404 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81405 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81406 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81407 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81408 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81410 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81411 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81412 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81413 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81414 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81415 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81416 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81417 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81420 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81422 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81425 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81426 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81427 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81430 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81431 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81432 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81433 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81434 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81435 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81436 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81437 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81438 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81439 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
|
Yes |
Yes |
|
81440 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81442 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81443 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
No |
|
81445 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81448 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81450 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81455 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81460 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81465 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81470 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81471 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81479 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81490 |
|
Investigational and experimental procedures |
Investigational lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81493 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81507 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81518 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81519 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81520 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81521 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81522 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
81538 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
5/1/2016 effective for Preauth. |
Yes |
Yes |
|
81540 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
5/1/2016 effective for Preauth. |
Yes |
Yes |
|
81541 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81542 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
No |
Yes |
|
81546 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
If test does not meet criteria in the policy, it would be invalid |
Yes |
No |
|
81551 |
|
Diagnostic services: Genetic testing |
Lab/Genetic testing |
Non covered for commercial product |
No |
Yes |
|
81552 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
86152 |
|
Investigational and experimental procedures |
Investigational lab test |
|
Yes |
Yes |
|
86153 |
|
Investigational and experimental procedures |
Investigational lab test |
|
Yes |
Yes |
|
87900 |
|
Investigational and experimental procedures |
LAB test |
|
Yes |
Yes |
|
87901 |
|
Investigational and experimental procedures |
LAB test |
|
Yes |
Yes |
|
87903 |
|
Investigational and experimental procedures |
LAB test |
|
Yes |
Yes |
|
87906 |
|
Investigational and experimental procedures |
LAB test |
|
Yes |
Yes |
|
88240 |
|
Transplant surgeries |
Blood or marrow stem cell transplants |
|
Yes |
Yes |
|
88245 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88248 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88249 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88261 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88262 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88263 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88264 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88267 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88269 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88271 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88272 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88273 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88274 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88275 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88280 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88283 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88285 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88289 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
88291 |
|
Lab/Genetic testing |
Lab/Genetic testing |
|
Yes |
Yes |
|
90281 |
|
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. |
Yes |
No |
|
90283 |
|
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. |
Yes |
No |
|
90284 |
|
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. |
Yes |
No |
|
90378 |
|
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. |
Yes |
No |
|
90867 |
|
Select outpatient behavioral health services |
Investigational Nerve stimulator |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
90868 |
|
Select outpatient behavioral health services |
Investigational Nerve stimulator |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
90869 |
|
Select outpatient behavioral health services |
Investigational Nerve stimulator |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
90870 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
Yes |
|
90997 |
|
Investigational and experimental procedures |
Dialysis Procedure |
|
Yes |
Yes |
|
93228 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
Yes |
|
93229 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
Yes |
|
93303 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93304 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93306 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93307 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93308 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93312 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured Products |
Yes |
Yes |
|
93313 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). Traditional products do not require preauthorization 1 applies to fully insured products |
Yes |
Yes |
|
93314 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
This service is preauthorized through National Imaging Associates (NIA). Traditional products do not require preauthorization 1 applies to fully insured products |
Yes |
Yes |
|
93315 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93316 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93317 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93318 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93350 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93351 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93352 |
|
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
93668 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
95782 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95783 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95800 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95801 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95805 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95806 |
|
Other services: Sleep studies facility based |
Sleep studies |
Preauthorization required when performed in a facility. |
Yes |
No |
|
95807 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95808 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95810 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95811 |
|
Other services: Sleep studies facility based |
Sleep studies |
|
Yes |
No |
|
95930 |
|
Investigational and experimental procedures |
Brain testing |
|
Yes |
No |
|
95980 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
Yes |
|
95982 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
Yes |
|
96567 |
|
Investigational and experimental procedures |
Skin procedure |
|
Yes |
No |
|
96573 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
No |
|
96574 |
|
Investigational and experimental procedures |
Investigational and experimental procedures |
|
Yes |
No |
|
96920 |
|
Outpatient surgery for select procedures |
Treatment of skin diseases |
|
Yes |
Yes |
|
96921 |
|
Outpatient surgery for select procedures |
Treatment of skin diseases |
|
Yes |
Yes |
|
96922 |
|
Outpatient surgery for select procedures |
Treatment of skin diseases |
|
Yes |
Yes |
|
97012 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97014 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
No |
|
97016 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97018 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97022 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97024 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97028 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97032 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97033 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
No |
|
97034 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97035 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97036 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97039 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97110 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97112 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97113 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97116 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97124 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97129 |
|
Therapy services: Occupational therapy |
Therapy services: Occupational therapy |
|
Yes |
Yes |
|
97130 |
|
Therapy services: Occupational therapy |
Therapy services: Occupational therapy |
|
Yes |
Yes |
|
97139 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97140 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97150 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97151 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97153 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97154 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97155 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97156 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97157 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97158 |
|
Select outpatient behavioral health services |
Behavioral health service |
This service is preauthorized through Beacon Health. |
Yes |
No |
|
97161 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97162 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97163 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97164 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97165 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97166 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97167 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97168 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97530 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97533 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97535 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97542 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97750 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97755 |
|
Therapy services: Occupational therapy |
Occupational therapy services |
|
Yes |
Yes |
|
97760 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97761 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97763 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
97799 |
|
Therapy services: Physical therapy |
Physical therapy services |
|
Yes |
Yes |
|
99183 |
|
Therapy services: Hyperbaric oxygen |
Hyperbaric oxygen |
|
Yes |
Yes |
|
99375 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99500 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99501 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99502 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99503 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99504 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99505 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99506 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99507 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99509 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
99511 |
|
Other services: Home health care |
Home health care |
|
Yes |
No |
|
A0430 |
Ambulance service, conventional air services, transport, one way (fixed wing) |
Office surgical procedures |
Non emergency ambulance transport |
|
Yes |
Yes |
|
A0431 |
Ambulance service, conventional air services, transport, one way (rotary wing) |
Other services: Ambulance services -Non Emergent |
Non emergency ambulance transport |
|
Yes |
Yes |
|
A0435 |
Fixed wing air mileage, per statute mile |
Other services: Ambulance services -Non Emergent |
Non emergency ambulance transport |
|
Yes |
Yes |
|
A0436 |
Rotary wing air mileage, per statute mile |
Other services: Ambulance services -Non Emergent |
Non emergency ambulance transport |
|
Yes |
Yes |
|
A4290 |
Sacral Nerve stimulation test lead, each |
Investigational and experimental procedures |
Nerve stimulator |
|
Yes |
Yes |
|
A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
Diabetic DME & supplies |
DME supplies |
|
Yes |
No |
|
A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, 1 unit = 1 day Supply |
Diabetic DME & supplies |
Diabetic Supplies |
|
Yes |
No |
|
A9277 |
Transmitter; external, for use with interstitial continuous glucose monitoring system |
Diabetic DME & supplies |
Diabetic Supplies |
|
Yes |
No |
|
A9278 |
Receiver (monitor); external, for use with interstitial continuous glucose monitoring system |
Diabetic DME & supplies |
Diabetic Supplies |
|
Yes |
No |
|
A9513 |
Lutetium LU 177, dotatate, therapeutic, 1 millicurie |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
Prime Therapeutics LLC will preauthorize service for BlueJourney through CoverMyMeds. |
No |
Yes |
|
B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4159 |
Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
Other services: enternal feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B9002 |
Enteral nutrition infusion pump - any type |
Other services: enteral feeding and supplies |
Special nutrient formula |
|
Yes |
Yes |
|
B9998 |
NOC for enteral supplies |
Other services: enteral feeding and supplies |
DME supplies |
|
Yes |
Yes |
|
C1764 |
Event recorder, cardiac (implantable) |
DME: implant |
DME Implant |
|
Yes |
Yes |
|
C1767 |
Generator, neurostimulator (implantable), non-rechargeable |
DME: prosthetic appliances and implants |
Nerve stimulator |
Facility code requires preauthorization |
Yes |
Yes |
|
C1772 |
Infusion pump, programmable (implantable) |
DME: implant |
DME pump |
|
Yes |
Yes |
|
C1778 |
Lead, neurostimulator (implantable) |
DME: prosthetic appliances and implants |
Nerve stimulator |
Facility code requires preauthorization |
Yes |
Yes |
|
C1783 |
Ocular implant, aqueous drainage assist device |
DME: prosthetic appliances and implants |
Prosthetic devices |
Facility code requires preauthorization |
Yes |
Yes |
|
C1787 |
Patient programmer neurostimulator |
DME: prosthetic appliances and implants |
Nerve stimulator |
Facility code requires preauthorization |
Yes |
Yes |
|
C1820 |
Generator, neurostimulator (implantable), with rechargeable battery and charging system |
Investigational and experimental procedures |
Investigational and experimental procedures |
Facility code requires preauth |
Yes |
Yes |
|
C1821 |
Interspinous process distraction device (implantable) |
DME: prosthetic appliances and implants |
Prosthetic devices |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
C1822 |
Generator, neurostimulator (implantable), high frequency , with rechargeable battery and charging system |
Investigational and experimental procedures |
Investigational Procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C1839 |
Iris prosthesis |
DME: Prosthetic appliances and implants |
Eye procedure |
|
Yes |
No |
|
C1883 |
Adaptor/extension, pacing lead or neurostimulator lead (implantable)
|
DME: prosthetic appliances and implants |
Nerve stimulator |
Facility code requires preauthorization |
Yes |
Yes |
|
C1891 |
Infusion pump, Nonprogrammable, permanent (implantable) |
DME: implant |
DME pump |
|
Yes |
Yes |
|
C1897 |
Lead, neurostimulator test kit (implantable) |
DME: prosthetic appliances and implants |
Nerve stimulator |
Facility code requires preauthorization |
Yes |
Yes |
|
C2616 |
Brachytherapy source, non-stranded, YTTRIUM-90, per source |
Therapy services: Radiation therapy |
Radiation therapy |
Facility code requires preauthorization. This service is preauthorized through National Imaging Associates (NIA). *Traditional Products do not require preauthorization |
Yes |
Yes |
|
C2626 |
Infusion pump, Nonprogrammable, temporary (implantable) |
DME: implant |
DME pump |
Facility code requires preauthorization |
Yes |
Yes |
|
C5271 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5272 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary Procedure) |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5273 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5274 |
Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5275 |
Application of low cost skin substitute graft to face, scalp, Eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area
|
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5276 |
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5277 |
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C5278 |
Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
Other services: Bio-engineered skin or biological wound care |
Skin procedure |
Facility code requires preauthorization |
Yes |
Yes |
|
C8900 |
Magnetic Resonance Angiography with contrast, abdomen |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8901 |
Magnetic Resonance Angiography without contrast, abdomen |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8902 |
Magnetic Resonance Angiography without contrast followed by with contrast, abdomen
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8903 |
Magnetic Resonance imaging with contrast, breast; unilateral |
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8905 |
Magnetic Resonance imaging without contrast, breast; unilateral
|
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8906 |
Magnetic Resonance imaging with contrast, breast; bilateral |
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8908 |
Magnetic Resonance imaging without contrast followed by with contrast, breast; bilateral |
Diagnostic services: MRI |
X-Ray/Imaging - MRI |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8909 |
Magnetic Resonance Angiography with contrast, Chest (excluding myocardium) |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8910 |
Magnetic Resonance Angiography without contrast, Chest (excluding myocardium)
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8911 |
Magnetic Resonance Angiography without contrast followed by with contrast, Chest (excluding myocardium) |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8912 |
Magnetic Resonance Angiography with contrast, lower extremity |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8913 |
Magnetic Resonance Angiography without contrast, lower extremity
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8914 |
Magnetic Resonance Angiography without contrast followed by with contrast, lower extremity
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -'Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8918 |
Magnetic Resonance Angiography with contrast, pelvis
|
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8919 |
Magnetic Resonance Angiography without contrast, pelvis |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8920 |
Magnetic Resonance Angiography without contrast followed by with contrast, pelvis |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8921 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; complete |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8922 |
Transthoracic echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; follow-up or limited study |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8923 |
Transthoracic echocardiography (TEE) with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, complete, without SPECTRAL or color doppler echocardiography |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8924 |
Transthoracic echocardiography (TEE) with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording when performed, follow-up or limited study |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8925 |
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation (2D) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8926 |
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8927 |
Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time (2D) image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8928 |
Transthoracic echocardiography (TTE) with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8929 |
Transthoracic echocardiography (TTE) with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8930 |
Transthoracic echocardiography (TTE) with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision |
Diagnostic services: Cardiac testing |
X-Ray/Imaging - Cardiac studies |
this service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require Preauthorization 1 Applies to Fully Insured products |
Yes |
Yes |
|
C8931 |
Magnetic Resonance Angiography with contrast, spinal canal and contents |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8932 |
Magnetic resonance angiography without contrast, spinal canal and contents |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8933 |
Magnetic Resonance Angiography without contrast followed by with contrast, spinal canal and contents |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8934 |
Magnetic Resonance Angiography with contrast, upper extremity |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8935 |
Magnetic Resonance Angiography without contrast, upper extremity |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). -Traditional Products do not require preauthorization |
Yes |
Yes |
|
C8936 |
Magnetic Resonance Angiography without contrast followed by with contrast, upper extremity |
Diagnostic services: MRA |
X-Ray/Imaging - MRA |
This service is preauthorized through National Imaging Associates (NIA). - Traditional Products do not require preauthorization |
Yes |
Yes |
|
C9061 |
Injection, teprotumumab-trbw, 10 mg |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. Prime Therapeutics LLC will preauthorize service for BlueJourney through CoverMyMeds |
Yes |
Yes |
|
C9069 |
Injection, belantamab mafodontin-blmf |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
This service is preauthorized by Capital BlueCross for Commercial. Claims should be submitted with National Drug Code (NDC) and supporting documentation. Preauthorization only for this specialty injectable |
Yes |
No |
|
C9070 |
Injection, tafasitamab-cxix, 2 mg |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
|
Yes |
No |
|
C9072 |
Injection immune globulin (asceniv), 500mg |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
|
Yes |
No |
|
C9073 |
Brexubabtagene autoleucel, up to 200 million autologoug anti-cd 19 car positive viable t cells, including leukapheresis and dose preparation proceudres, per therapeutic dose tacaretus |
Medical injectables/other non-injectable drugs |
Medical specialty drug |
|
Yes |
No |
|
C9739 |
Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants |
Investigational and experimental procedures |
Investigational bladder procedure |
|
Yes |
Yes |
|
C9740 |
Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants |
Investigational and experimental procedures |
Investigational bladder procedure |
|
Yes |
Yes |
|
C9757 |
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar |
Surgery for select procedures |
Nerve Procedures |
This service is preauthorized through Turning Point |
Yes |
Yes |
|
C9763 |
Cardiac Magnetic Resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging |
Diagnostic services: MRI |
Diagnostic services : MRI |
This service is preauthorized through National Imaging Associates (NIA). Traditional Products do not require Preauth. |
Yes |
Yes |
|
D0470 |
Diagnostic casts; also known as diagnostic models or study models. |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of socket bone and closure. |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7220 |
Removal of impacted tooth - soft tissue |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7230 |
Removal of impacted tooth - partially bony; part of crown covered by bone; requires mucoperiosteal flap elevation and bone removal |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7240 |
Removal of impacted tooth - completely bony; most or all of crown covered by bone; requires mucoperiosteal flap elevation and bone removal |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7241 |
Removal of impacted tooth - completely bony, with unusual surgical complications; most or all of crown covered by bone; unusually difficult or complicated due to factors such as nerve dissection required, separate closure of maxillary sinus required or aberrant tooth position |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7250 |
Removal of residual tooth roots (cutting procedure); includes cutting of soft tissue and bone, removal of tooth structure, and closure |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7270 |
Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth; includes splinting and/or stabilization |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7285 |
Incisional biopsy of oral tissue-hard (bone, tooth); for partial removal of specimen only. this procedure involves biopsy of osseous lesions and is not used for apicoectomy/periradicular surgery. this procedure does not entail an excision. |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7286 |
Incisional biopsy of oral tissue-soft; for partial removal of an architecturally intact specimen only. this procedure is not used at the same time as codes for apicoectomy/periradicular curettage. this procedure does not entail an excision |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7410 |
Excision of benign lesion up to 1.25 CM |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7413 |
Excision of malignant lesion up to 1.25 CM |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7440 |
Excision of malignant Tumor - lesion diameter up to 1.25 CM |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7450 |
Removal of benign odontogenic cyst or Tumor- lesion diameter up to 1.25 CM |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7460 |
Removal of benign nonodontogenic cyst or Tumor-lesion diameter up to 1.25 CM |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7465 |
Destruction of lesion(s) by physical or chemical method, by report; examples include using cryo, laser or electro surgery |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7471 |
Removal of lateral exostosis (maxilla or mandible) |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7472 |
Removal of torus palatinus |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7473 |
Removal of torus mandibularis |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7510 |
Incision and drainage of abscess - intraoral soft tissue; involves incision through mucosa, including periodontal origins |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7520 |
Incision and drainage of abscess - extraoral soft tissue; involves incision through skin |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7530 |
Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7540 |
Removal of reaction producing foreign bodies, musculoskeletal system; may include, but is not limited to, removal of splinters, pieces of wire, etc., from muscle and/or bone |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7620 |
Maxilla - closed reduction (teeth immobilized, if present); no incision required to reduce fracture. see d7610 if interosseous fixation is applied |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7640 |
Mandible - closed reduction (teeth immobilized, if present); no incision required to reduce fracture. see d7630 if interosseous fixation is applied |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7720 |
Maxilla - closed reduction |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7740 |
Mandible - closed reduction |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7820 |
Closed reduction of dislocation; joint manipulated into place; no surgical exposure |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7870 |
Arthrocentesis; withdrawal of fluid from a joint space by aspiration |
Office surgical procedures |
Dental procedures |
Requires preauthorization only performed in a facility. |
Yes |
Yes |
|
D7880 |
Occlusal orthotic device, by report; presently includes splints provided for treatment of temporomandibular joint dysfunction. |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
D7946 |
Lefort I (maxilla - total); sectioning of the upper jaw. This includes exposure, bone cuts, downfracture, repositioning, fixation, routine wound closure and normal post-operative follow-up care |
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
D7947 |
Lefort I (maxilla - segmented); when reporting a surgically assisted palatal expansion without downfracture, this code would entail a reduced service and should be "by report" |
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
D7948 |
Lefort II or Lefort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graft; sectioning of upper jaw. this includes exposure, bone cuts, downfracture, segmentation of maxilla, repositioning, fixation, routine wound closure and normal post-operative follow-up care |
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
D7949 |
Lefort II or Lefort III - with bone graft; includes obtaining autografts |
Reconstructive or cosmetic services: Augmentation and grafting |
Surgery - Head/Face |
|
Yes |
Yes |
|
D9942 |
Repair and/or reline of Occlusal GUARD |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
D9950 |
Occlusion analysis - mounted case; includes, but is not limited to, facebow, interocclusal records tracings, and diagnostic wax-up; for diagnostic casts, SEE D0470. |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
D9951 |
Occlusal adjustment - limited; may also be known as equilibration; reshaping the occlusal surfaces of teeth to create harmonious contact relationships between the maxillary and mandibular teeth. presently includes discing/odontoplasty/enameloplasty. typically reported on a "per visit" basis. this should not be reported when the procedure only involves bite adjustment in the routine post-delivery care for a direct/indirect restoration or fixed/removable prosthodontics |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
D9952 |
Occlusal adjustment - complete; occlusal adjustment may require several appointments of varying length, and sedation may be necessary to attain adequate relaxation of the musculature. study casts mounted on an articulating instrument may be utilized for analysis of occlusal disharmony. it is designed to achieve functional relationships and masticatory efficiency in conjunction with restorative treatment, orthodontics, orthognathic surgery, or jaw trauma when indicated. occlusal adjustment enhances the healing potential of tissues affected by the lesions of occlusal trauma |
Office surgical procedures |
Dental procedures |
Requires preauthorization only when performed in a facility. |
Yes |
No |
|
E0193 |
Powered air flotation bed (low air Loss therapy ) |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0194 |
Air fluidized bed |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0251 |
Hospital bed, fixed height, with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0255 |
Hospital bed, variable height, HI-LO, with any type side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0256 |
Hospital bed, variable height, HI-LO, with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0265 |
Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
No |
|
E0266 |
Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
No |
|
E0270 |
Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0277 |
Powered pressure-reducing air mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0290 |
Hospital bed, fixed height, without side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0291 |
Hospital bed, fixed height, without side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0292 |
Hospital bed, variable height, HI-LO, without side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0293 |
Hospital bed, variable height, HI-LO, without side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0294 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0296 |
Hospital bed, total electric (head, foot, and height adjustments), without side rails, with mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
No |
|
E0297 |
Hospital bed, total electric (head, foot, and height adjustments), without side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
No |
|
E0300 |
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0301 |
Hospital bed, heavy-duty, extra wide, with Weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
Yes |
Yes |
|
E0302 |
Hospital bed, extra heavy-duty, extra wide, with Weight capacity greater than 600 pounds, with any type side rails, without mattress |
DME: hospital beds & supplies |
Hospital bed |
|
<