Prior authorization codes
University of Utah Health Plans
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 26531 | ARTHROPLASTY, METACARPOPHALANGEAL JOINT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 27130 | TOTAL HIP ARTHROPLASTY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 27447 | TOTAL KNEE ARTHROPLASTY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 27487 | REVISE KNEE JOINT REPLACE, ALL PARTS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 27700 | ARTHROPLASTY ANKLE JOINT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29806 | SHOULDER ARTHROSCOPY, SURGICAL, CAPSULORRHAPHY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29820 | SHOULDER ARTHROSCOPY, PARTIAL SYNOVECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29834 | ELBOW ARTHROSCOPY, REMOVAL OF LOOSE BODY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29835 | ELBOW ARTHROSCOPY, PARTIAL SYNOVECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29836 | ELBOW ARTHROSCOPY, FULL SYNOVECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29837 | ELBOW ARTHROSCOPY, PARTIAL DEBRIDEMENT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29838 | ELBOW ARTHROSCOPY, EXTENSIVE DEBRIDEMENT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29844 | WRIST ARTHROSCOPY, PARTIAL SYNOVECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29846 | WRIST ARTHROSCOPY, EXCISION OF TRIANGULAR CARTILAGE | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29847 | WRIST ARTHROSCOPY, INTERNAL FIXATION | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29848 | WRIST ARTHROSCOPY, RELEASE OF TRANSVERSE LIGAMENT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29861 | HIP ARTHROSCOPY, REMOVAL OF LOOSE/FOREIGN BODY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29862 | HIP ARTHROSCOPY, REMOVAL OF BODY, CHONDROPLASTY/RESECTION | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29868 | KNEE ARTHROSCOPY, MENISCUS TRANSPLANT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29891 | ANKLE ARTHROSCOPY, EXCISION OSTEOCHONDRAL DEFECT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29895 | ANKLE ARTHROSCOPY, PARTIAL SYNOVECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29906 | ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29907 | ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29914 | ARTHROSCOPY HIP WITH FEMOROPLASTY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 29915 | ARTHROSCOPY HIP WITH ACETABULOPLASTY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 30520 | REPAIR OF NASAL SEPTUM | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31253 | NASAL/SINUS ENDOSCOPY TOTAL WITH FRONTAL SINUS EXPLORATION WITH TISSUE REMOVAL | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31254 | NASAL ARTHROSCOPY, REMOVAL PARTIAL ETHMOIDECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31255 | NASAL ARTHROSCOPY, REMOVAL TOTAL ETHMOIDECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31256 | NASAL ARTHROSCOPY, OPEN MAXILLARY SINUS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31257 | NASAL/SINUS ENDOSCOPY TOTAL WITH SPHENOIDOTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 31259 | NASAL/SINUS ENDOSCOPY TOTAL WITH ETHMOIDECTOMY, WITH SPHENOID TISSUE REMOVAL | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 41120 | PARTIAL REMOVAL TONGUE, <1/2 | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 55500 | REMOVAL OF HYDROCELE, SPERMATIC CORD, UNILATERAL | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58145 | EXCISION OF UTERINE FIBROID, VAGINAL APPROACH | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58146 | MYOMECTOMY 5/>, TOTAL >250 G, ABDOMINAL APPROACH | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58150 | TOTAL ABDOMINAL HYSTERECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58180 | SUPRACERVICAL ABDOMINAL HYSTERECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58291 | VAGINAL HYSTERECTOMY, UTERUS >250 G WITH REMOVAL OF TUBE(S) AND OVARY(S) | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58541 | LAPAROSCOPIC, SUPRACERVICAL HYSTERECTOMY <250G | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58542 | LAPAROSCOPIC, SUPRACERVICAL HYSTERECTOMY <250G, REMOVAL OF TUBE(S) AND OVARIE(S) | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58543 | LAPAROSCOPIC, SUPRACERVICAL HYSTERECTOMY >250G | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58544 | LAPAROSCOPIC, SUPRACERVICAL HYSTERECTOMY WITH TUBE(S) AND OVARY(S), >250G | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58545 | LAPAROSCOPIC, MYOMECTOMY 1 to 4 MYOMAS WITH TOTAL WEIGHT ≤ 250 G | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58554 | LAPAROSCOPIC, VAGINAL HYSTERECTOMY, UTERUS >250G, SALPINGO-OOPHORECTOMY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58661 | LAPAROSCOPIC, REMOVAL OF ADNEXAL STRUCTURE | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58700 | REMOVAL OF FALLOPIAN TUBE | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 58740 | LYSIS OF ADNEXAL ADHESIONS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59841 | INDUCED ABORTION BY DILATION AND EVACUATION | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59850 | INDUCED ABORTION BY INTRA-AMNIOTIC INJECTION | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59851 | INDUCED ABORTION BY INJECTION WITH DILATION AND CURETTAGE AND/OR EVACUATION | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59852 | INDUCED ABORTION BY INJECTION WITH OPEN UTERUS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59855 | INDUCED ABORTION BY VAGINAL SUPPOSITORY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59856 | INDUCED ABORTION BY VAGINAL SUPPOSITORY WITH DILATION AND CURETTAGE | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59857 | INDUCED ABORTION BY VAGINAL SUPPOSITORY WITH OPEN UTERUS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 59866 | MULTIFETAL PREGNANCY REDUCTION(S) (MPR) | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 70546 | MR ANGIOGRAPHY, HEAD, WITH AND WITHOUT CONTRAST | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 70549 | MR ANGIOGRAPHY, NECK, WITH AND WITHOUT CONTRAST | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 72198 | MR ANGIOGRAPHY, PELVIS (MRA) | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 73225 | MR ANGIOGRAPHY, UPPER EXTREMITIES | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 74185 | MR ANGIOGRAPHY, ABDOMEN (MRA) | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 77084 | MRI, BONE MARROW | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 77090 | TRABECULAR BONE SCORE (TBS), TECHNICAL PREPARATION AND TRANSMISSION OF DATA ANALYSIS | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 77091 | TBS TECHNICAL CALCULATION ONLY | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 77092 | TBS INTERPRETATION AND REPORT ON FRACTURE RISK BY OTHER QUALIFIED | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 78608 | BRAIN IMAGING PET METABOLIC | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |
| 83521 | IMMUNOGLOBULIN LIGHT CHAINS, FREE, EACH | 2024-02-01 | Not listed | 97% | [PDF] provider connection - The University of Utah |