New Codes Requiring Preauthorization
Starting February 1, 2022
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CPT Code
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CPT Code Description
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63664
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Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed
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Q2043
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Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion
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54401
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Insertion of penile prosthesis; inflatable (self-contained)
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54405
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Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
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54416
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Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session
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Codes Being Removed from Preauthorization List
As of January 1, 2022
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28285
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Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy)
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28289
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Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant
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28291
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Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant
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28292
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Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method
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28295
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Bunionectomy with proximal metatarsal osteotomy
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28296
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Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method
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28297
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Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method
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28298
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Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method
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28299
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Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method
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29805
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Arthroscopy, shoulder, diagnostic with or without synovial biopsy
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29806
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Arthroscopy, shoulder, surgical; capsulorrhaphy
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29807
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Arthroscopy, shoulder, surgical; repair of SLAP lesion
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29819
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Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
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29820
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Arthroscopy, shoulder, surgical; synovectomy, partial
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29821
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Arthroscopy, shoulder, surgical; synovectomy, complete
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29822
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Arthroscopy, shoulder, surgical; debridement, limited. Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures
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29823
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Arthroscopy, shoulder, surgical; debridement, extensive. Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures
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29824
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Arthroscopy, shoulder, surgical; distal claviculectomy, including distal articular surface
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29825
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Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation
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29826
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Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed
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29827
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Arthroscopy, shoulder, surgical; with rotator cuff repair
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29828
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Arthroscopy, shoulder, surgical; biceps tenodesis
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29834
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Arthroscopy, elbow, surgical; with removal of loose body or foreign body
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29836
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Arthroscopy, elbow, surgical; synovectomy, complete
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29838
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Arthroscopy, elbow, surgical; debridement, extensive
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29844
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Arthroscopy, wrist, surgical; synovectomy, partial
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29845
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Arthroscopy, wrist, surgical; synovectomy, complete
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29846
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Wrist arthroscopy with joint debridement or triangular fibrocartilage complex (TFCC) repair
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29848
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Endoscopy, wrist, surgical, with release of transverse carpal ligament
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29870
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Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
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29871
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Arthroscopy, knee, surgical; for infection, lavage and drainage
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29873
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Arthroscopy, knee, surgical; with lateral release
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29874
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Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)
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29875
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Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure)
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29876
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Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial or lateral)
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29877
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Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)
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29879
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Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture
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29880
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Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty)
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29881
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Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)
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29882
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Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)
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29883
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Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)
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29884
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Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)
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29887
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Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation
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29888
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Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction
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29889
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Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction
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29891
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Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect
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29892
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Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation
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29893
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Endoscopic plantar fasciotomy
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29894
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Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body
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29895
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Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial
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29897
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Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited
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29898
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Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive
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31231
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Nasal endoscopy, diagnostic, unilateral
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31237
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Nasal/sinus endoscopy, surgical with biopsy, polypectomy, or debridement (separate procedure)
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31239
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Nasal/sinus endoscopy, surgical with dacryocystorhinostomy. 30130 – Excision inferior turbinate, partial or complete, any method
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31240
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Nasal/sinus endoscopy, surgical; with concha bullosa resection
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31253
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Nasal/sinus endoscopy, surgical with ethimoidectomy total, including frontal sinus exploration, with removal of tissue from sinus, when performed
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31254
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Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
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31255
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Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
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31256
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Nasal/sinus endoscopy, surgical, with maxillary antrostomy
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31257
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Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus
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31259
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Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus
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31267
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Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus
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31276
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Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus
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31287
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Nasal/sinus endoscopy, surgical, with sphenoidotomy
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31288
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Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus
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58150
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Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(ies)
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58180
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Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(ies)
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58260
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Vaginal hysterectomy, for uterus 250 g or less
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58262
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Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(ies)
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58263
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Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(ies), with repair of enterocele
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58541
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Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less
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58542
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Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(ies)
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58543
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Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g
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58544
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Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(ies)
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58550
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Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less
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58552
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Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(ies)
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58553
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Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g
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58554
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Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(ies)
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58555
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Hysteroscopy, diagnostic (separate procedure)
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58558
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Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C
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58570
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Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less
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58571
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Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(ies)
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58572
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Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g
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58573
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Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(ies)
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58661
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Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
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58662
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Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
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58700
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Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
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58720
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Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)
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93228
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External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional
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93229
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External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days
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93530
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Right heart catheterization, for congenital cardiac anomalies
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93531
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Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
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93532
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Combined right heart catheterization and transseptal left heart catheterization through intact septum, with or without retrograde left heart catheterization, for congenital cardiac anomalies
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93533
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Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies
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93562
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Indicator dilution study; subsequent measurement of cardiac output
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93580
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Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrial septal defect) with implant
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95800
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Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
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95801
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Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
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