Jan 8th - 2013 CPT Codes

CareOregon Advantage Plus/Star
AND
CareOregon OHP Plus
NO AUTHORIZATION REQUIRED - CPT CODE LIST
Revised February 15, 2015
PLEASE NOTE: See Authorization Overview document for details regarding CareOregon's
CPT code changes occur annually and occasionally through out the year. It's important that
INSTRUCTIONS
1. Use this code list in conjuction with the Authorization Guidelines based on the member's
2. This list only applies when the services are performed in following settings:
a) office , b) ancillary, c) ASC for ASC approved procedures, and d) facility day patient/surgery
OHP MEMBERS - additional instructions:
1. For diagnostic (dx) procedures - Prioritized list does not apply
2. For treatment (tx) procedures - Prioritized list applies
Procedure Code
Dx or Tx
Procedure
10021-10022
10060-10180
11000-11057
11100-11101
Dx
Tx
Tx
Dx
11200-11201
11300-11313
11600-11646
11719-11765
11770-11772
11960-11976
11981-11983
12001-13160
14000-14350
15271-15276
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Tx
15277
15278
17000-17315
19000-19030
19100-19101
Tx
Tx
Tx
Tx
Dx
19105
19110-19120
19125-19272
19296-19298
20005-20150
20200-20251
20600-20610
20650-20696
Tx
Tx
Dx
Tx
Tx
Dx
Tx
Tx
Limitations or Special Instructions
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Biopsy Codes
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 1 of 11
20697
20900
21116
21310-21497
21501-21550
21557-21632
21800 - 21825
22010-22015
22305-22328
23065-23066
23077-23220
23350
23500-23680
23700
23930-23931
24065-24066
24077-24155
24500-24685
25000-25040
25065-25066
25077-25107
25246
25500-25695
26010-26037
26100-26110
26600-26785
26990-26991
27040-27041
27093-27095
27193 - 27269
27275
27280-27286
27290-27295
27301-27303
27323
27370
27372
27500-27566
27570
27580
27590-27598
27600-27612
27613-27614
27615-27616
27645-27647
27648
27750-27848
27860
Tx
Tx
Dx
Tx
Tx
Tx
Tx
Tx
Tx
Dx
Tx
Dx
Tx
Tx
Tx
Dx
Tx
Tx
Tx
Dx
Tx
Dx
Tx
Tx
Dx
Tx
Tx
Dx
Dx
Tx
Tx
Tx
Tx
Tx
Dx
Dx
Tx
Tx
Tx
Tx
Tx
Tx
Dx
Tx
Tx
Dx
Tx
Tx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Inj proc for TMJ arthrography
Biopsy Codes
Inj proc for shoulder arthrography
Biopsy Codes
Biopsy Codes
Inj proc for wrist arthrography
Biopsy Codes
Injection procedures.
Biopsy Code
Inj proc for knee arthrography
Biopsy Codes
Inj proc for ankle arthrography
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 2 of 11
27870-27871
27880-27889
28001-28005
28400-28675
28705-28760
28800-28825
29000-29515
29700-29750
29805-29863
29870-29907
30901-30920
31231-31235
31502
31505-31510
31511-31513
31515
31520
31525-31526
31527-31531
31535-31536
31540-31541
31545-31546
31560-31561
31570-31571
31575-31576
31577-31578
31579
31615
31620
31622-31626
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Dx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Dx
Dx
Tx
Dx
Tx
Tx
Tx
Tx
Dx
Tx
Dx
Dx
Tx
Dx
31627
31628-31629
31630-31631
31632-31633
31634-31649
Tx
Dx
Tx
Dx
Tx
31651-31661
31717
31720-31725
31730
32550-32557
32607-32609
33202-33249
35471-35476
36000
36002
36005
36010-36015
Tx
Dx
Dx
Tx
Tx
Dx
Tx
Tx
Tx
Tx
Dx
Tx
Arthroscopy
Arthroscopy
Diagnostic endoscopy
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 3 of 11
36100-36218
36221-36228
36245-36248
36251-36254
36260-36262
36400-36460
36555-36598
36600-36620
36625-36660
36800-36870
37184-37200
37211- 37217
Tx
Dx
Tx
Dx
37250-37251
38220-38221
38300
38500-38530
40490
Dx
Dx
Tx
Dx
Dx
40800
40808-40816
40830-40831
41019
41100-41108
41250-41252
41800-41806
41820-41850
42100
42180-42182
42300-42320
42700
43200
43201
43202
43204-43206
43211
43212-43229
43231-43232
43233
43235
43236
43237-43239
43240-43241
43242
43243-43251
Tx
Dx
Tx
Tx
Dx
Tx
Tx
Tx
Dx
Tx
Tx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
43252
43253-43254
43255
Tx
Dx
Tx
Tx
Tx
Dx
Tx
Tx
Tx
Tx
Biopsy Codes
Biopsy Code
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Biopsy Codes
Biopsy Codes
Biopsy Code
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 4 of 11
43257
43259
43260-43270
43752-43761
44388-44397
44970
45300-45387
Tx
Dx
Tx
Tx
Dx
Tx
Dx
45391-45392
46600-46615
46900-46924
47000-47001
47100
48400
49082-49084
49180
49400
49402-49436
49440-49465
50200
50551-50580
50590
50684-50690
50951-50980
51020-51597
51600-51610
51700-51720
51725-51798
52000-52010
52204-52318
52320-52346
52351
52352-52356
52400
Dx
Dx
Tx
Dx
Dx
Dx
Dx
Dx
Dx
Tx
Tx
Dx
Dx
Tx
Dx
Dx
Tx
Dx
Tx
Dx
Dx
Dx
Tx
Dx
Tx
Dx
52402
52450-52640
52647-52648
52649
53600-53601
53620-53661
54050-54055
54065
54100
54500-54505
54512-54535
54640-54650
54670
Dx
Tx
Tx
Tx
Tx
Tx
Tx
Tx
Dx
Dx
Tx
Tx
Tx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Colonoscopy through stoma
Endoscopy procedures including colonscopy
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Endoscopy procedures
Biopsy Codes
Biopsy Code
Inj proc for pancreatography
Biopsy Code
Biopsy Code
Endoscopy procedures
Inj proc for ureterography/ureterophyelography
Endoscopy procedures
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Biopsy Code
Biopsy Codes
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 5 of 11
55250
Tx
55300-55400
55700-55706
55875-55876
56405-56440
56501-56515
56605-56606
56820-56821
57022-57023
57061-57065
57100-57105
57150-57180
57420-57421
57423-57452
57454-57460
57461
57500
57505-57522
57530-57531
57800
58100-58110
58120
Tx
Dx
Tx
Tx
Tx
Dx
Dx
Tx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Tx
Tx
Dx
Tx
58300
58301
Tx
Tx
58340
Dx
58565
Tx
58600-58615
Tx
58670-58671
58673
59000-59070
59100-59160
59412
59812-59830
59840-59866
Tx
Tx
Tx
Tx
Tx
Tx
Tx
59870
60000
60100
60200-60281
60500-60650
Tx
Tx
Dx
Tx
Tx
Vasectomy - No auth applies to OHP mbrs only!
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Biopsy Codes
Biopsy Codes
Endoscopy procedures
Biopsy Codes
Biopsy Codes
No auth applies to OHP mbrs only. Excluded svc for COA
mbrs.
No auth applies to OHP mbrs only
Cath/intro of saline/contrast for sonohysterography or
hysterosalpingography
Sterilization proc- No auth applies to #1) OHP mbrs only
AND #2) when done in an office setting! Auth required if
done in ASC or hospital setting! Sterilization consent is
required.
Sterilization proc- No auth applies to OHP mbrs only!
Sterilization consent is required. Auth required for COA
mbrs.
No auth applies to OHP mbrs only! Auth required for COA
mbrs.
Abortions
Biopsy Code
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 6 of 11
61070
61796-61800
62267
62270
62272-62273
62284
62290-62291
62365
62367-62370
63620-63621
63661-63664
Tx
Tx
Dx
Dx
Tx
Dx
Dx
Tx
Tx
Tx
Tx
Inj procedure for myelography
Inj procedure for discography
64718-64721
Tx
65270-65286
Tx
66761-66762
Tx
66820-66825
Tx
66830-66986
Tx
67005-67040
Tx
67220-67229
Tx
67311-67340
Tx
67810
Dx
Biopsy Code
69000-69020
Tx
69100-69105
Dx
Biopsy Codes
69990
Dx
Radiology including Nuclear Medicine and Diagnostic Ultrasound CPT Codes
70010-70553
Dx
Diagnostic radiology
No auth applies to COA mbrs only! Excluded svc for OHP
70554-70555
Dx
mbrs.
70557-72158
Dx
Diagnostic radiology.
No auth applies to OHP mbrs only! Excluded svc for COA
72159
Dx
mbrs.
72170-73223
Dx
Diagnostic radiology
No auth applies to OHP mbrs only! Excluded svc for COA
73225
Dx
mbrs.
73500- 74260
Dx
Diagnostic radiology/ultrasound/mammography/bone
74270-74740
Dx
studies.
No auth applies to COA mbrs only! Excluded svc for OHP
74742
Dx
mbrs.
74775-76376
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
76377
Dx
mbrs.
76380-77082
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
77084
Dx
mbrs.
77261-77372
Tx
Radiation oncology procedures
No auth applies to COA mbrs only! Excluded svc for OHP
77373
Tx
mbrs.
77399-77432
Tx
Radiation oncology procedures
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 7 of 11
77435
77469-77799
78012-78350
Tx
Tx
Dx
78351
78414-78458
78466-78483
78494-78607
78610-78808
78999
79005-79999
Dx
Dx
Dx
Dx
Dx
Dx
Tx
80047-80102
80150-80412
Dx
Dx
80414, 80415
80416-81099
81206-81208
81210
81220-81224
81240-81251
81255-81257
81261-81264
81267-81275
81292-81342
81370-82106
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
82107
82108-82608
Dx
DX
82610
82615-82747
Dx
Dx
82757
82759-83690
Dx
Dx
83695-83704
83718-83887
83915-83986
83992-84022
Dx
Dx
Dx
Dx
84030
84035-84144
Dx
Dx
84145
84146-84430
Dx
Dx
84431
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Radiation oncology procedures
Nuclear medicine
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Nuclear medicine
Nuclear medicine
Nuclear medicine
Nuclear medicine
Nuclear medicine
Radiopharmaceutical therapy
Pathology and Laboratory CPT Codes
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Genetic Testing for Cystic Fibrosis
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 8 of 11
84432-84704
Dx
84830
84999-86304
86308-86355
Dx
Dx
Dx
86356
86357-86384
Dx
Dx
86386
86403-86431
86485-86890
Dx
Dx
Dx
86891
86900-86906
86920-86950
Dx
Dx
Dx
86960
86965-87149
87150
87152
87153
87158-87807
87808
87809-87999
88104-88121
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
88125
88130-88241
88280-88381
88387-88720
89049-89230
Dx
Dx
Dx
Dx
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
89240
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Medicine CPT Codes
91000-91299
90935-90997
90999
Dx
Tx
Tx
Dialysis/End Stage Renal Disease Services
91111, 91117
91120-91122
92002-92014
Dx
Dx
Tx
92015
92018-92020
92025
92060
Dx
Tx
Dx
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Refractive exam - No auth applies to CareOregon
Advantage members, OHP Plus children (<21) and OHP
Plus adults who are pregnant or have a diagnosis of
aphakia or keratonconus.
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 9 of 11
92065
92081-92287
92502-92504
92511-92524
92531-92534
92540-92558
92560-92588
92590-92591
Tx
Dx
Dx
Dx
Dx
Dx
Dx
Dx
92592-92593
92594-92595
92610-92617
92960-92961
92973-92998
93000-93229
93260-93261
93268-93278
93279-93284
93285
93286-93290
93291
93292-39296
93297-93352
93355
93451-93568
93571-93657
93660
93662-93668
Dx
Dx
Dx
Tx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
Dx
Tx
93701
93724-93790
93880-93888
Dx
Dx
Dx
93890-93893
93922-93998
94010-94450
Dx
Dx
Dx
94452-94453
94620-94621
94640-94668
94680-94799
95250-95830
95831-95852
95857-95927
Dx
Dx
Tx
Dx
Dx
Dx
Dx
95928-95929
95939-95975
95978-95979
Dx
Dx
Dx
Vestibular function tests
Audiologic function tests
Audiologic function tests
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Cardioversion
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Pulmonary studies
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Pulmonary studies
Pulmonary tx procedures
Pulmonary studies
Diagnostic tests
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 10 of 11
95980-95982
95990-96004
96360-96549
96365-96379
96401-96425
96440-96549
97597-97602
Dx
Dx
Tx
Tx
Tx
Tx
Tx
97760-97761
Tx
97810-97811,
97813-97814
98925-98929
99143-99150
99170-99173
99175
Tx
Tx
Tx
Dx
Dx
No auth applies to COA mbrs only! Excluded svc for OHP
mbrs.
Injections and infusions
Chemotherapy for FDA approved agent only!
Other injection & infusion services
Orthotic management & prosthetic training by orthopedic
surgeon only! All other providers, authorization is required!
When performed in a PCP office; chemical dependency
treatment; OHP members receiving Hospice care; or a
diagnosis of HIV
CareOregon NO authorization required CPT Code List - Revised 2/15/15- Page 11 of 11