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Prior Authorization List

The “Prior Authorization List” is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to payment authorization.

Members and providers are encouraged to obtain prior authorization and may call Customer Service to inquire about the need for prior authorization. While the list below covers the medical services, drugs, and procedures that require authorization prior to rendering; Blue Shield may require additional information after the service is provided.

If further information is required to process the payment Blue Shield’s Claims department will reach out and will request the specific information at that time. Before providing service please contact Customer Service or access the provider connection website to verify the service is a covered benefit.

Blue Shield of California Providers

Prior authorization for the services listed below is highly recommended. For more information on obtaining prior authorization review refer to your provider manual. If authorization was not obtained prior to the service being rendered, the service will likely be reviewed for medical necessity at the point of claim.

Please include medical records when you are ready to submit for claim payment, review our medical policies, and verify the service is a covered benefit online through our provider connection website or contact Customer Service. If prior authorization was obtained and you are submitting an offline (i.e. paper) claim, remember to attach a copy of the prior authorization letter.

Prior Authorization Requirements for Out-of-Area Blue Plan Members
Please go to the “Managing Out-Of-area Blue Plan Member” section and view medical policy and general prior authorization requirements for your patients who are covered by an out-of-area Blue Plan.

Radiology and Imaging Services

Prior authorization medical necessity reviews are highly recommended for certain non-emergency outpatient radiology procedures (CT, MRI, MRA, PET, cardiac nuclear medicine) for Administrative Services Only (ASO), HMO Direct Contracting and PPO plans. Review requests for services within California are performed by National Imaging Associates. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583).

For out of state and Point of Service (POS) authorization requests, review the below list and submit to Blue Shield for the select radiological service or procedure.

Spine Surgery and Pain Management Services

Prior authorization medical necessity reviews are highly recommended for certain spinal procedures (spinal surgery, spinal injections, spinal implants) for Administrative Services Only (ASO), HMO Direct Contracting, and PPO plans. Review requests for services within California are performed by National Imaging Associates. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583).

Federal Employee Program

Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization.

Out-of-Area Providers

If you are an Out-of-Area provider treating a Blue Shield of California member, contact the customer service phone number on the back of the member’s card to verify if the service is a covered benefit under the plan and to verify if prior authorization is required.

Prior Authorization List

Medical Policy Procedure Codes
Accelerated Breast Irradiation After Breast-Conserving Surgery for Early Stage Breast Cancer and Breast Brachytherapy as Boost With Whole-Breast 0395T, 19296, 19297, 19298, 77770, 77771, 77772, 77778, C9726
Actigraphy 95803
Administrative-Medical-- Air Ambulance A0430
Administrative-Medical-- Chemotherapy 96542
Administrative-Medical-- Factor for the Treatment of Hemophilia J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7198, J7199
Administrative-Medical-- Hemodialysis 90937
Administrative-Medical-- Intensive Outpatient Services Substance Abuse H0015
Administrative-Medical-- Other Home Hospice Q5010
Administrative-Medical-- Partial Hospitalization H0035
Administrative-Medical-- Peritoneal Dialysis 90945
Administrative-Medical-- Shift Care S9123
Administrative-Medical--Home Infusion S9379
Administrative-Medical--Intensive Outpatient Services Mental Health S9480
Administrative-Medical-Charged-Particle (Proton or Helium Ion) Radiotherapy 77520, 77522, 77523, 77525
Administrative-Medical-Hip Resurfacing at Alta Bates Summit Medical Center (Bundled Episode of Care) 27130
Administrative-Medical-Total Knee Replacement at Hoag Memorial Hospital, Orthopedic Institute,  or Alta Bates Summit Medical Center (Bundled Episode of Care) 27447
Asparaginase Erwinia chrysanthemi (Erwinaze) EUSA Pharma J9019
Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer 81519, S3854
Auditory Brainstem Implants S2235
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions 27412, J7330, S2112
Azacitidine (VidazaTM) Pharmion J9025
Balloon Ostial Dilation for Treatment of Chronic Sinusitis 31295, 31296, 31297
Bariatric Surgery 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43999
Belatacept (Nulojix®) Bristol-Myers Squibb J0485
Belimumab (Benlysta®) GlaxoSmithKline J0490
belinostat (Beleodaq™) J9032
Bendamustine (Treanda®) Cephalon J9033
Beta-Amyloid Imaging With Positron Emission Tomography for Alzheimer Disease 78811, 78814
Bevacizumab (Avastin®), Genentech J9035
Biofeedback as a Treatment of Urinary Incontinence in Adults 90901, 90911, E0746
Blepharoplasty, Blepharoptosis Repair, (Levator  Resection) and Brow Lift (Repair of Brow Ptosis) 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909
Blinatumomab (Blincyto®) J9039
Bortezomib (Velcade®) Millenium J9041
Botulinum Toxin A AbobotulinumtoxinA (Dysport®) J0586
Botulinum Toxin A IncobotulinumtoxinA (Xeomin®) J0588
Botulinum Toxin B RimabotulinumtoxinB (Myobloc®) J0587
Botulinum Toxin Type A OnobotulinumtoxinA (Botox®) Allergan J0585
Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds 77316, 77317, 77318, 77778
Brentuximab vedotin (AdcetrisTM) Seattle Genetics J9042
C1 Esterase Inhibitor (Berinert®; CLS Behring, Cinryze®; Lev Pharmaceuticals) J0597, J0598
C1EsteraseInhibitorRecombinant (RUCONEST) J0596
Cabazitaxel (Jevtana ®) Sanofi-Aventis J9043
Calcitonin-Salmon (Miacalcin®) Novartis J0630
Canakinumab (Ilaris®) Novartis J0638
Capsaicin 8% patch (Qutenza®) NeurogesX, Inc J7336
Cardiac Applications of Positron Emission Tomography Scanning 78459, 78491, 78492
Carfilzomib (Kyprolis®) J9047
Caspofungin (Cancidas®) Merck J0637
Certolizumab pegol (Cimzia®) UCB J0717
Cetuximab (Erbitux®), Bristol-Myers Squibb J9055
Charged-Particle (Proton or Helium Ion) Radiotherapy 77520, 77522, 77523, 77525
Clinical Trials S9988, S9990, S9991, S9992, S9994, S9996
Clofarabine (Clolar®) Genzyme, Inc. J9027
Cochlear Implant 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, L8629
Collagenase clostridium histolyticum (Xiaflex®) Auxilium Pharmaceuticals J0775
Computed Tomography to Detect Coronary Artery Calcification 75571, S8092
Computer-Aided Evaluation of Malignancy With Magnetic Resonance Imaging of the Breast 0159T
Continuous Passive Motion in the Home Setting E0935, E0936
Continuous or Intermittent Monitoring of Glucose in Interstitial Fluid S1030, S1031
Corticotropin, repository (H.P. Acthar® Gel); Questcor J0800
Cryosurgical Ablation of Miscellaneous Solid Tumors Other Than Liver, Prostate, or Dermatologic Tumors 0340T, 19105, 20983, 50250, 50542, 50593
dalbavancin (Dalvance™) J0875
Dalteparin (Fragmin®) Pfizer J1645
Darbepoetin alfa (Aranesp®) Amgen J0881
Decitabine (Dacogen®) MGI Pharma J0894
Degarelix, Firmagon® Ferring Pharmaceuticals J9155
denosumab (Prolia™) Amgen J0897
denosumab (Xgeva) Amgendenosumab (Xgeva) Amgen J0897
Dexamethasone intravitreal implant (Ozurdex®) J7312
Dihydroergotamine mesylate injection (D.H.E. 45®) J1110
Dolasetron, Intravenous (Anzemet®) Sanofi Aventis J1260
Ecallantide (Kalbitor®) Dyax J1290
Eculizumab (Soliris®) Alexion J1300
Electrostimulation and Electromagnetic Therapy for Treating Wounds E0761, E0769, G0282, G0295
Elosulfase alfa (Vimizim®) J1322
Endobronchial Brachytherapy 31643, 77316, 77317, 77318, 77761, 77762, 77763, 77770, 77771, 77772
Enoxaparin (Lovenox®) Aventis J1650
Epoetin alfa (Procrit®) Ortho Biotech J0885
Epoprostenol (Flolan®) Gilead or generic manufacturers (Veletri®) Actelion Pharmaceuticals J1325
Eribulin (Halaven) Eisai J9179
Etanercept (Enbrel®) Amgen, Inc. J1438
External Insulin Infusion Pump E0784
Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions 0101T, 0102T, 28890
Filgrastim, G-CSF, (Neupogen®) J1442
filgrastim-sndz (Zarxio®) Q5101
Fluocinolone Intravitreal implant (Iluvein®) J7313
Fluocinolone Intravitreal implant (Retisert®) J7311
Fondaparinux (Arixtra®), GlaxoSmithKline J1652
Fosaprepitant (Emend®), Mfg by DSM Pharmaceuticals, Inc. for Merck & Co., Inc. J1453
Fulvestrant (Faslodex®), AstraZeneca J9395
Functional Neuromuscular Electrical Stimulation E0744, E0764, E0770
Galsulfase (Naglazyme®), Biomarine J1458
Gastrointestinal Motility and Manometry Testing 91010, 91013, 91020, 91022, 91117, 91120, 91122
Gender Reassignment Surgery 11920, 11921, 11922, 11960, 11970, 11971, 15770, 19301, 19303, 19304, 19340, 19342, 31750, 53410, 53430, 54125, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 54520, 54660, 54690, 55150, 55175, 55180, 55970, 55980, 56620, 56625, 56800, 56805, 56810, 57106, 57107, 57110, 57111, 57291, 57292, 57295, 57296, 57335, 57426, 57530, 58150, 58180, 58260, 58262, 58263, 58270, 58275, 58280, 58285, 58290, 58291, 58292, 58293, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58555, 58570, 58571, 58572, 58573, 58661, 58720, 58940, C1813, C2622
Genetic Testing for Familial Alzheimer’s Disease 81406
Genetic Testing for Inherited Thrombophilia 81240, 81241, 81291
Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes 81201, 81202, 81203, 81210, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, 81319, 81401, 81403, 81406
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy 81406, 81479
Genetic Testing of CADASIL Syndrome 81406
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer 81479, 81599
Golimumab (Simponi Aria®) J1602
Growth Hormone (GH) in Adults and Children,Somatropin Products:(Humatrope®), Eli Lilly (Nutropin®/NutropinAQ®), Genentech (Genotropin®), Pharmacia/Pfizer (Norditropin®), NovoNordisk (Saizen®), Serono (Tev-Tropin®), Teva (Omnitrope®), Sandoz J2941
High-Dose Rate Temporary Prostate Brachytherapy 77316, 77317, 77318, 77770, 77771, 77772, 77778
Histrelin implant (Supprelin LA®) Indevus J9226
Histrelin implant (Vantas™) Indevus J9225
Hyaluronic acid (Euflexxa® Ferring) J7323
Hyaluronic acid (Gel One®/  Seikagaku) J7326
hyaluronic acid (Gel-Syn) J7328
Hyaluronic acid (Hyalgan® Fidia/Sanofi Supartz® Seikagaku /Smith and Nephew) J7321
Hyaluronic acid (Monovisc®) J7327
Hyaluronic acid (Orthovisc®) J7324
Hyaluronic acid (Synvisc® , Synvisc One®) J7325
Hydroxyprogesterone caproate injection (Makena, KV Pharmaceuticals) J1725
Hyperbaric Oxygen Therapy 99183, A4575, E0446, G0277
Ibandronate (Boniva®), Roche J1740
Ibritumomab (Zevalin®), Cell Therapeutics, Inc (CTI), Biogen Idec A9542, A9543
icatibant (Firazyr®) Shire J1744
Idursulfase (Elaprase®) Shire J1743
Iloprost inhalation (Ventavis®), CoTherix Q4074
Imiglucerase (Cerezyme®) Genzyme J1786
Immune Globulin, Intravenous IVIG 90291, J0850, J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599
Immune Globulin, Subcutaneous (Hizentra® 20%), CSL Behring J1559, J1575
Implantable Bone-Conduction and Bone-Anchored Hearing Aids 69710, 69711, 69714, 69715, 69717, 69718, L8690, L8691, L8693
Implantable Cardioverter Defibrillator 33216, 33217, 33230, 33231, 33240, 33249, 33262, 33263, 33264, 93287, 93640, 93641, C1721, C1722, C1777, C1882, C1895, C1896, G0448
Implantation of Intrastromal Corneal Ring Segments 65785
Infliximab-dyyb (Inflectra®) Q5102
infliximab (Remicade®), Centocor J1745
Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence 51715, L8603, L8606
Interferon Alfa 2b (Intron A®), Schering J9214
Interferon Alfa-n3 (Alferon N®), Purdue J9215
Interferon gamma-1b (Actimmune®), InterMune J9216
Interim Positron Emission Tomography Scanning in Oncology to Detect Early Response During Treatment 78811, 78812, 78813, 78814, 78815, 78816
Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain 77761, 77762, 77763, 77770, 77771, 77772
Ipilimumab (Yervoy) Bristol-Myers Squibb J9228
isavuconazonium (Cresemba®) J1833
IV Antibiotics for Tickborne Infections J0456, J0558, J0561, J0696, J0698, J1956, J2540
Ixabepilone (Ixempra®), Bristol-Myers Squibb J9207
KRAS Mutation Analysis in Non-Small-Cell Lung Cancer 81403
KRAS, NRAS, and BRAF Mutation Analysis in Metastatic Colorectal Cancer 81210, 81406
Knee Arthroplasty for Adults 27447, 27486, 27487, 27488
Knee Braces L1840, L1844, L1846
Laboratory Tests for Heart Transplant Rejection 84999
Lanreotide (Somatuline®); Ipsen Pharma Biotech J1930
Laronidase (Aldurazyme®) BioMarin Pharmaceutical J1931
Laser, Light Therapy, and Cryotherapy for Acne Vulgaris 17110, 17111, 17340, 96900, 96920
levoleucovorin inj (Fusilev®) Spectrum Pharmaceuticals J0641
Linezolid (Zyvox®) Pharmacia and Upjohn/Pfizer J2020
Lower Limb Prostheses L5100, L5105, L5150, L5160, L5200, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5617, L5700, L5701, L5702, L5930, L5990
Magnetic Resonance Imaging for Detection and Diagnosis of Breast Cancer 77058, 77059, C8903, C8904, C8905, C8906, C8907, C8908
Magnetic Resonance Imaging to Monitor the Integrity of Silicone Gel-Filled Breast Implants 77058, 77059, C8903, C8904, C8905, C8906, C8907, C8908
Measurement of Exhaled Nasal Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders 95012
Measurement of Lipoprotein-Associated Phospholipase A2 in the Assessment of Cardiovascular Risk 83698
Mecasermin (Increlex®), Tercica J2170
methoxy polyethylene glycol-epoetin beta (Mircera®) J0888
methylnaltrexone (Relistor®) J2212
Micafungin (Mycamine®) Astellas Pharma J2248
Microprocessor-Controlled Prostheses for the Lower Limb L5856, L5857, L5858, L5859, L5973
Miscellaneous (Noncardiac, Nononcologic) Applications of Fluorodeoxyglucose F 18 Positron Emission Tomography 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816
Multigene Expression Assay for Predicitng Recurrence in Colon Cancer 84999
Multiple Sclerosis Drug Therapy Glatiramer (Copaxone®, Glatopa) J1595
Multiple Sclerosis Drug Therapy Interferon beta 1A (Avonex®), Biogen J1826
Multiple Sclerosis Drug Therapy Interferon beta 1B (Betaseron®), Chiron, (Extavia®), Novartis J1830
Natalizumab (Tysabri®) Biogen Idec J2323
Negative Pressure Wound Therapy in the Outpatient Setting 97605, 97606, A6550, A9272, E2402, K0743, K0744, K0745, K0746
Neuropsychological Testing 96116, 96118, 96119, 96120
NIA Radiology 70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71250, 71260, 71270, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 75557, 75559, 75561, 75563, 75565, 75572, 75573, 75635, 76380, 77011, 77012, 77021, 77084, 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, 78499, S8037
Nivolumab (Opdivo®) J9299
Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA 81422, 81479, 81507, 81599, 84999
Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease 82172, 82610, 82664, 83695, 83700, 83701, 83704, 85384, 85385
Obinutuzumab (Gazyva®) J9301
Ocriplasmin (Jetrea®) J7316
Octreotide (Sandostatin® SC/IV), Novartis J2354
Octreotide IM inj (Sandostatin LAR Depot®), Novartis J2353
Ofatumumab (Arzerra®) GlaxoSmithKline J9302
Olanzapine Long-actingInjection (Zyprexa® RelprevvTM), Eli Lilly J2358
Omacetaxine (Synribo®) J9262
Omalizumab (Xolair®) Genentech J2357
Oncologic Applications of Positron Emission Tomography Scanning 78608, 78609, 78812, 78813, 78815, 78816, G0252, S8085
Orthognathic Surgery 21085, 21110, 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21247, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7995, D7996
Orthopedic Applications of Platelet-Rich Plasma 0232T
Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) 38206, 38230, 38241
Orthoptic Training for the Treatment of Vision or Learning Disabilities J92065
oritavancin (Orbactiv™) J2407
Paclitaxel protein bound suspension (Abraxane®)Abraxis oncology J9264
Palifermin (Kepivance®); Amgen J2425
Paliperidone (Invega Sustenna®) Janssen J2426
Palivizumab (Synagis®), MedImmune 90378
Palonosetron (Aloxi®); Distributed by Eisai Inc. Licensed by Helsinn J2469
Panitumumab (Vectibix®) J9303
Panniculectomy, Abdominoplasty and Surgical Management of Diastasis Recti 15830, 15847
Pasireotide diaspartate (Signifor®, Signifor LAR®) J2502
Pegaptanib (Macugen®); Pfizer J2503
pegfilgrastim (Neulasta®) J2505
Pegloticase (Krystexxa) Savient Pharmaceuticals J2507
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence E0740
pembrolizumab (Keytruda®) J9271
Pemetrexed (Alimta), Eli Lilly J9305
peramivir (Rapivab™) J2547
Percutaneous Tibial Nerve Stimulation 64566
Pertuzumab (Perjeta®) J9306
Plerixafor (Mozobil®), Genzyme J2562
Positron Emission Mammography 78811, G0235
Power Wheelchairs and Power Operated Vehicles for Permanent Use E1016, E1018, E2300, E2301, E2310, E2311, E2351, E2358, E2360, E2362, E2364, E2367, E2372, E2609, E2610, E2617, K0669, K0806, K0807, K0808, K0830, K0831, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886
Pralatrexate (Folotyn®) Allos Therapeutics J9307
Prolotherapy M0076
Protein C concentrate (human) (Ceprotin®) Baxter J2724
Radioembolization for Primary and Metastatic Tumors of the Liver 37243, 75894, 77399, 77778, 79445, C2616, S2095
Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors 20982, 32998, 50542, 50592, 76940, 77013, 77022
Ramucirumab (Cyramza®) J9308
Ranibizumab (Lucentis®) Genentech J2778
Reduction Mammaplasty for Breast-Related Symptoms 19318
Rilonacept (Arcalyst®)  Regeneron J2793
Risperidone Long-acting Injection (Risperdal Consta®), Janssen J2794
Rituximab (Rituxan®), Genentech J9310
Romidepsin (Istodax®) J9315
Romiplostim (Nplate™) Amgen J2796
Sargramostim, GM-CSF (Leukine®), Berlex J2820
Semi-Implantable and Fully Implantable Middle Ear Hearing Aids 69799, S2230, V5095
Siltuximab (Sylvant) J2860
Sumatriptan injection(Imitrex®) GlaxoSmithKline(Sumavel™ Dosepro™) Zogenix J3030
Surgical Deactivation of Headache Trigger Sites 15824, 15826, 30130, 30140, 30520, 64716, 67900
Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea 64999
Surgical Treatment of Bilateral Gynecomastia 19300, 19301, 19303, 19304
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome 21685, 41512, 41530, 42145, 42299
Taliglucerase alfa (Elelyso®) J3060
Tbo-Filgrastim (Granix®) J1447
tedizolid (Sivextro™) J3090
Temporomandibular Joint Dysfunction 97024, 97026
Temsirolimus (Torisel®) J9330
Teriparatide (Forteo®) Eli Lilly J3110
Testosterone undecanoate (Aveed®) J3145
Tocilizumab (Actemra®) J3262
Total Hip Arthroplasty for Adults 27125, 27130, 27132, 27134, 27137, 27138, S2118
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders 90867, 90868, 90869
Trastuzumab (Herceptin®) Genentech J9355
Treatment of Varicose Veins/Venous Insufficiency 36468, 36470, 36471, 36475, 36476, 36478, 36479, 37500, 37765, 37766, S2202
Treprostinil IV (Remodulin®) United Therapeutics J3285
Treprostinil inhalation (Tyvaso®) United Therapeutics J7686
Ultrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Atherosclerosis 0126T
Unlisted-Pharmacy J3490, J3590, J7699, J7799, J8499, J8999, J9999
Ustekinumab (Stelara®) Centocor J3357
Vedolizumab (Entyvio®) J3380
Velaglucerase alfa (VPRIV™) Shire J3385
Vincristine liposome (Marqibo®) J9371
Virtual Colonoscopy/Computed Tomography Colonography 74261, 74262, 74263
Wearable Cardioverter Defibrillators 93292, 93745, K0606, K0607, K0608, K0609
Whole Gland Cryoablation of Prostate Cancer 55873
Wireless Capsule Endoscopy to Diagnose Disorders of the Small Bowel, Esophagus, and Colon 91110, 91111
Ziconotide (Prialt®), Elan J2278
ZivAflibercept (Zaltrap®) J9400
zoledronic Acid (Reclast®, Zometa) J3489