Search procedure codes

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All seeded codes26 matches

73721ImagingPrior auth: commonly required

MRI of a lower-extremity joint, without contrast

A magnetic resonance scan of a joint in the leg — usually the knee, but also the hip or ankle. It produces detailed pictures of soft tissue like cartilage, ligaments, and tendons without using dye.

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70553ImagingPrior auth: commonly required

MRI of the brain with and without contrast

A detailed magnetic resonance scan of the brain, performed twice — once without dye and once after contrast — to highlight blood vessels, tumors, infections, or areas of inflammation.

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72148ImagingPrior auth: commonly required

MRI of the lumbar spine, without contrast

A detailed scan of the lower back to look at discs, nerves, and the spinal canal without using dye.

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74177ImagingPrior auth: sometimes required

CT of the abdomen and pelvis with contrast

A cross-sectional X-ray scan of the belly and pelvis with IV dye to highlight organs, blood vessels, and possible problem areas.

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45378EndoscopyPrior auth: not commonly required

Diagnostic colonoscopy

A camera exam of the entire large intestine done with sedation, used to look for the cause of symptoms or to follow up on prior findings.

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45380EndoscopyPrior auth: not commonly required

Colonoscopy with biopsy

A colonoscopy during which one or more tissue samples are taken for the lab to examine.

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95810Sleep MedicinePrior auth: commonly required

Sleep study (polysomnography), attended in a lab

An overnight sleep recording done in a sleep lab to look for sleep apnea, abnormal movements, or other sleep disorders.

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29881SurgeryPrior auth: commonly required

Knee arthroscopy with meniscus repair/trim

A minimally invasive surgery that uses a small camera and instruments inserted through tiny incisions to repair or trim damaged cartilage in the knee.

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43775SurgeryPrior auth: commonly required

Sleeve gastrectomy (bariatric surgery)

A weight-loss operation in which most of the stomach is removed, leaving a smaller, sleeve-shaped pouch.

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19318SurgeryPrior auth: commonly required

Breast reduction (reduction mammaplasty)

Surgery to remove excess breast tissue, skin, and fat to reduce breast size and relieve related symptoms.

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97110TherapyPrior auth: sometimes required

Physical therapy — therapeutic exercises

A physical therapy session focused on therapeutic exercise to improve strength, flexibility, or function. Billed in 15-minute units.

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90837Behavioral HealthPrior auth: plan dependent

Psychotherapy, 60 minutes

A one-hour individual psychotherapy session with a licensed mental-health clinician.

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90791Behavioral HealthPrior auth: not commonly required

Psychiatric diagnostic evaluation

An initial intake visit with a mental-health clinician to gather history and establish a diagnosis and treatment plan.

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J0178Specialty DrugPrior auth: commonly required

Aflibercept (Eylea) injection

An injection given into the eye to treat certain retinal conditions like wet macular degeneration or diabetic eye disease.

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J1745Specialty DrugPrior auth: commonly required

Infliximab (Remicade) infusion, per 10 mg

An IV infusion of a biologic medication used for autoimmune diseases like Crohn's, ulcerative colitis, rheumatoid arthritis, and psoriasis.

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99204Office VisitPrior auth: not commonly required

New patient office visit, 45 minutes

An office visit with a clinician you have not seen recently, lasting about 45 minutes of total provider time.

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93306CardiologyPrior auth: sometimes required

Echocardiogram, complete with Doppler

An ultrasound of the heart that shows the chambers, valves, and blood flow.

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27447SurgeryPrior auth: commonly required

Total knee replacement

A surgery that replaces the damaged surfaces of the knee joint with metal and plastic components.

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62323Pain ManagementPrior auth: commonly required

Lumbar epidural steroid injection

An injection of steroid medication near the nerves in the lower back, done under imaging guidance, to reduce inflammation.

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11102DermatologyPrior auth: not commonly required

Skin biopsy, tangential

Removal of a small surface sample of skin for the lab to examine.

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76700ImagingPrior auth: not commonly required

Ultrasound of the abdomen, complete

An ultrasound exam of the upper abdomen — typically the liver, gallbladder, pancreas, kidneys, and spleen.

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77067Preventive ImagingPrior auth: not commonly required

Screening mammogram, bilateral

A routine breast X-ray used to screen for breast cancer in people without symptoms.

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G0439PreventivePrior auth: not commonly required

Annual wellness visit (Medicare)

A yearly Medicare visit focused on prevention — health risk assessment, screening planning, and a personalized prevention plan.

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31237ENTPrior auth: not commonly required

Diagnostic nasal/sinus endoscopy

A thin camera exam of the nasal passages and sinuses, often done in the ENT office.

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64483Pain ManagementPrior auth: commonly required

Transforaminal epidural injection, lumbar/sacral

A targeted steroid injection near a specific spinal nerve root in the lower back, done under imaging guidance.

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20610OrthopedicsPrior auth: not commonly required

Major joint injection (knee, shoulder, hip)

An injection into a large joint — usually steroid or anesthetic — done in the office to reduce pain and inflammation.

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