New Codes Requiring Prior Approval

Effective December 1, 2017, the following Current Procedural Terminology (CPT) codes will require prior approval for benefit plans in the following Networks:*

  • Enhanced Care Prime Network
  • HIP Premium Network**
  • HIP Prime Network
  • NY Metro Network**
  • Select Care Network
  • Medicare Essential Network
  • VIP Prime Network

*Excludes Monte CMO
**Members are being transitioned to the HIP PRIME Network upon renewal. Transition will be completed by December 31, 2017.

These CPT codes are limited to the specialties as indicated in the table below.

Procedure Code Description Specialty
29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed Orthopedics
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair Orthopedics
36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family Vascular Surgery
37221 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed Vascular Surgery
37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty Vascular Surgery
37226 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed Vascular Surgery
37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed Vascular Surgery
38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) Surgery
47562 Laparoscopy, surgical; cholecystectomy Surgery
49585 Repair umbilical hernia, age 5 years or older; reducible Surgery
50590 Lithotripsy, extracorporeal shock wave Urology
52000 Cystourethroscopy (separate procedure) Urology
55700 Biopsy, prostate; needle or punch, single or multiple, any approach Urology
67255 Scleral reinforcement (separate procedure); with graft Ophthalmology
93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography Cardiology, Cardiothoracic Surgery
93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed Cardiology, Cardiothoracic Surgery
93650 Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement Cardiology, Cardiothoracic Surgery
93886 Transcranial Doppler study of the intracranial arteries; complete study Cardiology, Neurology
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour Hematology/Oncology, Rheumatology, Neurology
96415 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) Hematology/Oncology, Rheumatology, Neurology