Prior Auth Required

42835 - Use the following CPT codes when billing for ENT services

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceUse the following CPT codes when billing for ENT services
Procedure / Service Description

Procedures - Procedures A referral from the member’s PCP will be required unless the member is an Administrative Member. Use the following CPT codes when billing for ENT services: 42820, 42821, 42825, 42826, 42830, 42831, 42835, 42836, 42860, 69424, 69433, 69436, 69440, 69450, 69631. CCS review referral required for the following CPT codes: 42820, 42821, 42825, 42826, 42830, 42831, 42835,

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.