Oregon CPT Preapproval Grid
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- Carol Powers
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1 * The following grid only identifies items that require preapproval from Excision benign lesion Blepharoplasty Notes: If Opthamologist requesting, pre-auth is not required Breast repair or reconstruction Mammaplasty, augmentation with or without prosthetic implant Notes: If breast cancer diagnosis, pre-auth is not required Breast repair or reconstruction Electrical stimulation non-invasive Electrical stimulation operative Low intensity ultrasound (US) for bone stimulation Spinal procedures Spinal procedures Spinal procedures Arthrodesis Heart/lung transplant Endovenous Ablation Therapy Treatment of varicose veins Laparoscopic Gastric Bypass with Small Bowel Resection Page 1 of 5
2 * The following grid only identifies items that require preapproval from Other Laparoscopic Gastric Procedures Laparoscopic Bariatric Procedures Open Bariatric, Gastric Procedures Freeing of intestinal adhesions Pancreas Transplant Hernia repair Laparoscopy Kidney Transplant Plastic surgery on penis; insertion and repair of prosthesis Plastic repair of introitus, clitoroplasty, perineoplasty Hysterectomy, abdominal and vaginal enterocele repair Vaginal hysterectomy Vaginal hysterectomy with laparoscopy Unlisted laparoscopy procedures, uterus Laparoscopy/Lysis of Adhesions Laparoscopy/Lysis of Adhesions Oophrectomy/Laparotomy Page 2 of 5
3 * The following grid only identifies items that require preapproval from Reduction of craniomegaly Cranioplasty procedures Neurolysis & Injection/Aspiration of Spine, Diagnostic/Therapeutic Injection/Infusion Diagnostic/Therapeutic Material Procedures Related to Epidural and Interthecal Catheters Posterior Midline Laminectomy/Laminotomy/Decompression & Cervical Laminoplassty Procedures Spinal cord procedures Spinal Neurostimulation Transforaminal Injection Peripheral nerve neurostimulators Decompression and/or Transposition of Nerve Decompression and/or Transposition of Nerve Decompression and/or Transposition of Nerve Corneal transplant Corneal procedures Implantation of hearing device Cochlear implant & unlisted Page 3 of 5
4 * The following grid only identifies items that require preapproval from Magnetic Resonance Imaging (MRI) Temporomandibular Joint Notes: If for dentofacial anomalies, osteoarthrosis, dislocation of jaw, pre-auth is not required Magnetic Resonance Imaging (MRI) Orbit, Face, or Neck Magnetic Resonance Imaging (MRI) Brain Magnetic Resonance Imaging (MRI) Chest Magnetic Resonance Imaging/Magnetic Resonance Angiography (MRI/MRA) spinal canal Magnetic Resonance Imaging (MRI) Pelvis Magnetic Resonance Imaging (MRI) Upper Extremity Magnetic Resonance Imaging (MRI) Lower Extremity Magnetic Resonance Imaging (MRI) Abdomen - General Magnetic Resonance Imaging (MRI) Heart Structure and Physiology Unlisted Ultrasound Procedure Magnetic Resonance Imaging (MRI) breast Magnetic Resonance Imaging (MRI) Bone Marrow Blood Supply Nuclear cardiac testing Heart Positron Emission Tomography (PET) Brain Positron Emission Tomography (PET) Tumor Positron Emission Tomography (PET) Page 4 of 5
5 * The following grid only identifies items that require preapproval from Biofeedback Biofeedback Speech/language services Speech/language services Unlisted neurological or neuromuscular diagnostic procedure Neuro-psych testing Health and Behavior Assessment and Intervention Notes: Effective 10/1/2011, pre-auth required for units > 10 per member per year Physical medicine & rehabiliation Medical Nutrition Therapy Notes: If diabetes diagnosis, pre-auth is not required Chiropractic manipulation Hyperbaric Page 5 of 5
Oregon CPT Preapproval Grid
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