CurrentSelectHealthPolicy N/A

Medicare codes not covered or requiring preauthorization - Colorado

A quarterly-updated list of Medicare procedure codes that SelectHealth either does not cover or requires preauthorization for, specific to Colorado members; applies to coverage determination and prior authorization processes.

Policy Summary

PayerSelectHealth

PolicyMedicare codes not covered or requiring preauthorization - Colorado

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 26, 2026

Next Review DateN/A

Key ActionObtain prior authorization for any CPT/HCPCS codes marked as Preauthorization Required (X) before providing the service.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

dozensprocedure codes preauth

severalcodes Not Covered

quarterlyupdate frequency

Coloradojurisdiction

Code-level Coverage and Authorization Designations

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Selected code stances

Excerpted code-level stances from the list:

22614 — Preauthorization Required (Preauthorization Required = X).

22630 — Preauthorization Required (Preauthorization Required = X).

22862 — Not Covered (Not Covered = X).

27215 — Not Covered (Not Covered = X).

28446 — Not Covered (Not Covered = X).

General criteria

General coverage notes and exceptions

Coverage may vary by plan type; coding lists are updated quarterly and do not reflect immunizations, injectable drugs, or specialty medications (those are handled via Pharmacy).

Document disclaimer and scope.

Each listed CPT/HCPCS code is annotated in the document with either 'Not Covered = X' or 'Preauthorization Required = X' to indicate coverage exclusion or prior authorization requirement respectively.

Per-code flags shown in the roster.

Code-level stances

Per-code coverage indicators

44705 — Listed as Not Covered (Not Covered = X).

43775 — Listed as Preauthorization Required (Preauthorization Required = X).

50360 — Transplant code listed as Preauthorization Required (Preauthorization Required = X).

Per-code coverage/authorization nodes (selected examples)

Per-code coverage indicators:

58542 — Preauthorization Required (Preauthorization Required = X).

61736 — Not Covered in segment (Not Covered = X).

62263 — Not Covered (Not Covered = X).

62330 — Preauthorization Required (Preauthorization Required = X).

63015 — Preauthorization Required (Preauthorization Required = X).

Code-level coverage nodes (examples)

Selected codes are explicitly marked as Not Covered or Preauthorization Required. Examples below reflect the document's code-level stance.

65760 — Not Covered (Not Covered = X) — revision of cornea entries shown as Not Covered.

66985 — Preauthorization Required (Preauthorization Required = X) — insert lens prosthesis.

64490 — Preauthorization Required (Preauthorization Required = X) — facet joint injection codes.

64628 — Preauthorization Required (Preauthorization Required = X) — thermal destruction of basivertebral nerve.

Per-code stances (sample extraction)

Per-code coverage stance (examples from this window):

80335 — Not Covered (drug/metabolite test classes marked Not Covered = X).

80348 — Not Covered (buprenorphine testing listed Not Covered = X).

80354 — Not Covered (fentanyl testing listed Not Covered = X).

81162 — Preauthorization Required (BRCA sequencing/duplication entries shown with Preauthorization Required = X).

81225 — Preauthorization Required (pharmacogenomic variant testing shown Preauthorization Required = X).

Per-code stance examples

Per-code coverage stance examples from this excerpt:

81240 — Not Covered (F2 prothrombin 20210G>A variant listed Not Covered = X).

81241 — Not Covered (F5 Leiden variant listed Not Covered = X).

81243 — Not Covered (FMR1 evaluation listed Not Covered = X).

81244 — Not Covered (FMR1 characterization listed Not Covered = X).

81251 — Not Covered (GBA common variants listed Not Covered = X).

81255 — Not Covered (HEXA common variants listed Not Covered = X).

Per-code preauthorization examples

Per-code preauthorization examples from this excerpt:

81226 — Preauthorization Required (CYP2D6 gene analysis marked Preauthorization Required = X).

81228 — Preauthorization Required (genomic microarray analysis marked Preauthorization Required = X).

81232 — Preauthorization Required (DPYD gene analysis marked Preauthorization Required = X).

81236 — Preauthorization Required (EZH2 full gene sequence marked Preauthorization Required = X).

81301 — Preauthorization Required (Microsatellite instability analysis marked Preauthorization Required = X).

Per-code coverage stance (examples)

Per the listed items, codes are either marked as requiring preauthorization or (rarely) explicitly not covered.

81305 — Preauthorization Required (Preauthorization Required = X).

81355 — Not Covered (81355 explicitly marked Not Covered = X).

81403 — Preauthorization Required (Preauthorization Required = X).

Per-code coverage/authorization flags (examples)

Per-code coverage flags in the Colorado list

81419 — Preauthorization Required (Preauthorization Required = X).

81493 — Not Covered (Not Covered = X).

81560 — Not Covered (Not Covered = X).

81449 — Preauthorization Required (Preauthorization Required = X).

General criteria

General coverage notes and exclusions

Coverage may vary by plan type; code lists are updated quarterly; immunizations, injectable drugs, and specialty medications are not represented and should be referred to Pharmacy.

Document-level disclaimer.

As of date shown in document: 03/26/26.

Timestamp provided in roster.

Audiology and Vision coverage stance

Example coverage stance by code group

Audiology/hearing codes (e.g., 92632, 92634, 92641) — marked Not Covered (Not Covered = X) in the list.

Special spectacles/vision fitting codes (e.g., 92352, 92353) — Preauthorization Required (Preauthorization Required = X) for selected codes.

Coverage stance for listed codes

Codes in these lists are either explicitly not covered or require prior authorization as indicated next to each code.

92632, 92633, 92634 — Not Covered (Not Covered = X) for multiple audiology/hearing service codes.

92700, 93580, 93702 — Preauthorization Required (Preauthorization Required = X) for selected otolaryngology and cardiovascular procedure codes.

Telehealth coverage stance

Selected synchronous audio-video and audio-only telehealth visit codes are marked Not Covered in this section.

98000, 98001, 98002, 98003 — Synchronous audio-video new patient E/M codes — Not Covered (Not Covered = X).

98004, 98005, 98006, 98007 — Synchronous audio-video established patient E/M codes — Not Covered (Not Covered = X) for multiple duration-based codes.

Per-code coverage stance examples

Codes in this list are categorized per-code as Not Covered or Preauthorization Required. Examples below reflect the per-code markings as presented.

98943 — Not Covered (Not Covered = X).

98940 — Preauthorization Required (Preauthorization Required = X*).

99417 — Not Covered (listed Not Covered = X in consultation/E/M segment).

99183 — Preauthorization Required (Hyperbaric oxygen therapy marked Preauthorization Required = X).

Per-code coverage designations

Per-code coverage designation entries (examples shown):

0005F — Not Covered (Not Covered = X).

0005U — Preauthorization Required (Preauthorization Required = X).

0036U — Preauthorization Required (Preauthorization Required = X).

0071T — Not Covered (Not Covered = X).

Representative CPT/HCPCS Code Groups and Status

Not Covered / Experimental Drug and Toxicology Panels (Selected)CPTNot Covered

80346	Benzodiazepines; 1-12 — Toxicology panel (listed as Not Covered in source).
80347	Benzodiazepines; 13 or more — Toxicology panel.
80348	Buprenorphine — Toxicology panel.
80349	Cannabinoids, natural — Toxicology panel.
80350	Cannabinoids, synthetic; 1-3 — Toxicology panel.

Not Covered / Toxicology and Drug Class Panels (Additional examples)CPTNot Covered

80324	Amphetamines; 1 or 2 — Toxicology panel (Not Covered).
80325	Amphetamines; 3 or 4 — Toxicology panel (Not Covered).
80326	Amphetamines; 5 or more — Toxicology panel (Not Covered).
80331	Analgesics, non-opioid; 6 or more — Toxicology panel (Not Covered).

Covered / Laboratory Panels and Molecular (examples)CPTCovered

81162	BRCA1, BRCA2 full sequence and duplication/deletion analysis — Preauthorization Required (Covered with criteria in source).
81163	BRCA1 full sequence analysis — Preauthorization Required (Covered with criteria in source).

What Providers Must Do — Prior Authorization & Denial Risk

Prior Authorization

Prior Authorization Required

Many procedure codes in this list require prior authorization before scheduling or billing; codes marked “Preauthorization Required = X” must have prior authorization. Codes marked “Not Covered = X” are excluded and will be denied if billed. Verify member plan coverage and obtain authorization where required.

Preauthorization Required = X indicates prior authorization is required.
Not Covered = X indicates the service is excluded from coverage.
Coverage and authorization requirements may vary by plan — check member-specific benefits.

Prior Authorization

Breast Surgery — Prior Authorization

Breast and reconstructive surgery CPT codes frequently require prior authorization. Examples below show many breast surgery and reconstruction codes flagged for preauthorization.

19300, 19316, 19318, 19325, 19328, 19330 — Preauthorization Required = X
19340, 19342, 19350, 19357, 19361, 19364, 19367, 19368, 19369 — Preauthorization Required = X
19370, 19371, 19380, 19499 — Preauthorization Required = X

Prior Authorization

Spine & Neurosurgery — Auth and Not Covered Flags

Spine and neurosurgical procedures include many codes that either require prior authorization or are designated Not Covered. Obtain authorization for fusion, interbody device insertion, tethering, and many decompression/laminotomy procedures.

22590, 22595, 22600, 22612, 22614, 22630, 22632, 22633, 22634 — Preauthorization Required = X
22800, 22802, 22804, 22808, 22810, 22812, 22836, 22837, 22838, 22853, 22854 — Preauthorization Required = X
22861, 22862 — 22862 marked Not Covered = X; 22861, 22864–22870 marked Preauthorization Required = X
Codes 61736, 61737, 62263, 62264, 62287 — several of these are marked Not Covered = X (neurosurgical exclusions)

Prior Authorization

Preauthorization Required — Selected Excerpt

Selected examples from across the code list illustrating preauthorization-required entries (not exhaustive). Providers must secure authorization per plan rules before providing these services.

Aesthetic/dermatologic: 11960, 11970, 11971, 15775–15793, 15788–15793 — Preauthorization Required = X
Cardiac/valve: 33340, 33361–33369 — Preauthorization Required = X
Vascular/vein procedures: 36465–36476, 37215, 37217–37218 — Preauthorization Required = X
Bariatric/gastric: 43774, 43775, 43843–43848 — Preauthorization Required = X
Hysterectomy/laparoscopic gynecologic: 58542–58554 — Preauthorization Required = X

Prior Authorization

Interventional Pain Procedures — Prior Authorization

Interventional pain and spine pain procedures often require prior authorization or are excluded — confirm for epidural adhesiolysis, facet/nerve injections, ablations, implantable pumps and neurostimulation.

Facet/zygapophyseal injections: 64490–64495 — Preauthorization Required = X
Epidural adhesiolysis: 62263–62264 — many entries Not Covered = X
Spine implant/pump codes: 62330, 62350–62362, 62380 — Preauthorization Required = X
Neurostimulation/ablation: 64505, 64553, 64581–64596, 64624, 64628 — Preauthorization Required = X (some nerve ablation codes may be Not Covered)

Prior Authorization

Genetic / Molecular Testing — Prior Authorization

Genetic, molecular, and genomic panel testing codes are commonly subject to prior authorization. Many molecular pathology and multigene panel CPT codes require review before testing.

Single-gene and pharmacogenomic: 81225–81229, 81239–81250 — many marked Preauthorization Required = X
Molecular pathology levels and panels: 81400 series (81403–81408, 81419, 81425–81434, etc.) — Preauthorization Required = X
Genomic sequencing panels / liquid biopsy: 81459, 81460, 81462–81465 — Preauthorization Required = X
Oncology and prognostic panels: 81500–81523 — Preauthorization Required = X

Denial Risk

Not Covered — Examples

Not-covered examples: certain procedures, tests, and immunizations are explicitly excluded and will be denied. Check member-specific benefit design; when a code is marked Not Covered = X, do not expect payment.

Orthopedics/pelvis: 27217, 27218 — Not Covered = X
Vein procedures: 36468 — Not Covered = X
Transplant/donor procedures: select donor prep and transplant codes may be Preauthorization Required = X but some related services are Not Covered
Immunizations and IG products: 90281, 90291, 90384, 90386, 90389 — many marked Not Covered = X
Diagnostic imaging and advanced MR spectroscopy: 76019, 76140, 76390 — Not Covered = X

Prior Authorization

Preauthorization and Not Covered Indicators — Provider Actions

Code-level coverage flags matter operationally: treat any code documented with Not Covered = X as excluded; treat Preauthorization Required = X as actionable — obtain authorization before service. Some codes include plan-specific exceptions or footnotes (e.g., entries flagged with * or plan-specific modifiers).

Always check the member’s plan and benefits; coverage may vary by plan type.
Some codes are updated quarterly — confirm the current coding list prior to authorization.
When in doubt, contact SelectHealth provider services or submit a preauthorization request to avoid claim denials.

Prior Authorization

Pathology, Reproductive Medicine & Immunization/IG Notes

Additional pathology, reproductive medicine, and immunization/immune globulin notes: many reproductive medicine lab and IVF procedure codes (89240 series, 89250–89398) require prior authorization. Certain immune globulin and immunization services are Not Covered or require prior authorization depending on code.

Reproductive: 89240, 89250, 89254–89290, 89337, 89398 — Preauthorization Required = X
Pathology/genetics: 88271–88399, 88749, 89240 — Preauthorization Required = X
Immune globulin / immunizations: 90281 (Human IG IM) Not Covered = X; 90399 Immune globulin Preauthorization Required = X; 90482–90484 (immunization counseling) Not Covered = X

Note

Provider Summary — Prior Authorization & Denial Risk

Summary — what providers must do: verify member coverage, consult the quarterly updated code list, obtain prior authorization for any code marked Preauthorization Required = X, and do not bill codes marked Not Covered = X. For questions about specialty medications, immunizations, or injectables, use the Pharmacy link on the SelectHealth website.

Obtain prior authorization for codes marked Preauthorization Required = X before rendering services.
Do not bill codes marked Not Covered = X — they will be denied.
Refer specialty medication, injectable drug, and immunization questions to the Pharmacy link on SelectHealth’s website.
Coding lists are updated quarterly — always confirm the current list before scheduling or billing.

Key Definitions and Disclaimers

inv-100: Preauthorization Required definition

Definition'Preauthorization Required = X' indicates SelectHealth requires prior authorization for the listed code before the service is performed.

UsageAn 'X' placed in the Preauthorization Required column next to a CPT/HCPCS code signals the provider must obtain prior authorization for that code.

EffectServices billed with codes marked Preauthorization Required = X may be denied without prior authorization.

inv-101: Not Covered definition

Definition'Not Covered = X' indicates SelectHealth does not cover the listed CPT/HCPCS code for the specified Colorado Medicare list.

UsageAn 'X' in the Not Covered column marks the service as excluded from coverage under the listed scope.

Provider actionProviders should not bill for services marked Not Covered = X; verify alternative coverage pathways if needed.

inv-102: Disclaimer / update frequency — coding lists updated quarterly; exclusions noted.

Update frequencyCoding lists are updated quarterly.

Scope exclusionLists do not reflect immunizations, injectable drugs, or specialty medications; refer to Pharmacy resources for those items.

Plan variationCoverage may vary by plan type; entries apply to the Colorado Medicare-specific list.

inv-103: Preauthorization Required (alternate reference).

Alternate phrasingCodes marked with an 'X' under Preauthorization Required indicate SelectHealth requires prior authorization before the service is performed.

Visual indicatorThe document displays Preauthorization Required entries as 'X' in the Preauthorization column beside each code.

ImplicationMany surgical, genetic, and procedure codes in the Colorado list are shown as Preauthorization Required = X.

inv-104: Not Covered (alternate reference).

Alternate phrasingAn 'X' in the Not Covered column indicates the code is excluded from coverage for the specified scope (Colorado Medicare list).

Document notationThe list uses 'Not Covered = X' to mark exclusions alongside per-code descriptions.

ActionProviders should confirm Not Covered entries before providing services to Colorado Medicare members.

inv-105: Preauthorization Required — indicator usage.

Indicator meaningAn 'X' in the Preauthorization Required field indicates prior authorization is required for that code.

Displayed symbolPreauthorization Required is often shown as 'X' in the document's Preauthorization column.

Provider requirementObtain authorization when a code shows Preauthorization Required = X to avoid claim denial.

inv-106: Not Covered — indicator usage.

Indicator meaning'Not Covered = X' flags codes that are excluded from coverage under the Colorado list.

Displayed symbolThe document uses 'X' in the Not Covered column next to code entries to denote exclusion.

Provider implicationServices marked Not Covered = X are not reimbursed; verify alternative benefits or medical necessity exceptions as applicable.

inv-107: Definition — Not Covered (short).

Short definitionNot Covered = X: service/code excluded from coverage under this Colorado list.

ScopeApplies to codes shown in the Colorado Medicare roster.

Update noteLists updated quarterly; plan variation may apply.

inv-108: Definition — Preauthorization Required (short).

Short definitionPreauthorization Required = X: prior authorization must be obtained before the service is performed for coverage consideration.

Displayed asTypically shown as an 'X' in the Preauthorization Required column beside the code.

Affected codesNumerous surgical, genetic, and procedural CPT/HCPCS codes in the Colorado list are marked Preauthorization Required = X.

inv-109: Preauthorization Required = X (usage).

EquivalenceWhen a code row shows 'Preauthorization Required = X', it is interpreted in the document as 'Preauthorization Required' and requires prior authorization.

ExamplesMany spine and surgical codes (e.g., 22614, 22630) in the list display Preauthorization Required = X.

ActionProviders should request prior authorization per SelectHealth procedures for codes so marked.

inv-110: Not Covered = X (usage).

EquivalenceWhen a code row shows 'Not Covered = X', it denotes the payer does not cover that code under the listed Colorado Medicare context.

ExamplesExamples in the list include pelvic and fracture codes (e.g., 27217, 27218) marked Not Covered = X.

Provider guidanceDo not submit claims expecting payment for codes marked Not Covered = X unless an exception applies.

inv-111: Disclaimer / scope (alternate).

Scope disclaimerCoverage may vary by plan type; coding lists are updated quarterly.

Pharmacy exclusionImmunizations, injectable drugs, and specialty medications are not included in these coding lists and are managed via the Pharmacy section.

Document dateThe roster is presented with an 'As of' date indicating the snapshot (e.g., 03/26/26).

inv-112: Preauthorization indicator (alternate).

IndicatorAn 'X' in the Preauthorization Required field marks the code as requiring prior authorization.

PresentationThe document reproduces the Preauthorization column where an X indicates requirement and a hyphen or blank indicates not required.

ConsequenceClaims for services with this indicator may be denied if authorization is not obtained.

inv-113: Preauthorization Required marked with 'X' (definition).

Definition'Preauthorization Required' when marked with 'X' means the provider must secure prior authorization from SelectHealth before providing the service for which the code is billed.

Displayed formThe mark is shown as 'X' in the Preauthorization Required column of the code listing.

ExamplesNumerous codes across specialties (surgery, genetics, imaging) are marked with this 'X' in the source list.

inv-114: Not Covered marked with 'X' (definition).

Definition'Not Covered' when marked with 'X' indicates the service/code is excluded from coverage in the Colorado Medicare list.

Displayed formThe mark appears as 'X' in the Not Covered column next to the code entry.

ExamplesSeveral diagnostic, audiology, and genetic entries are shown as Not Covered = X in the list.

inv-115: Disclaimer — coverage may vary by plan type; quarterly updates; immunizations/injectable/specialty meds excluded.

Plan variation disclaimerCoverage may vary by plan type; verify applicability to the member's line of business.

Update cadenceThe code lists are updated quarterly — check the most current roster before authorizing or delivering services.

ExclusionsImmunizations, injectable drugs, and specialty medications are excluded from these lists and routed to Pharmacy resources.

inv-116: Coverage status notation (document usage).

NotationDocument uses 'Not Covered = X' and 'Preauthorization Required = X' as coverage-status notations beside each code.

SymbolsAn 'X' denotes the active status; hyphen or blank denotes not applicable or not required.

Provider actionReview the per-code notation column to determine whether to seek prior authorization or consider a code excluded.

inv-117: Disclaimer / Coverage variability (additional).

Coverage variabilityCoverage decisions shown may differ by plan type and are specific to the Colorado Medicare list; confirm for the member's plan.

Quarterly updatesThe roster is maintained on a quarterly schedule; consult the latest version for up-to-date statuses.

Pharmacy itemsImmunizations/injectables/specialty medications are not represented here and are handled via Pharmacy resources.

inv-118: Preauthorization Required (definition alternate).

Alternate definitionA mark 'X' next to a code in the Preauthorization column indicates prior authorization is required before the service for coverage consideration.

PresentationCommonly represented as 'Preauthorization Required = X' in the code listings.

ImplicationProviders should follow SelectHealth's prior authorization procedures for codes so marked.

inv-119: Not Covered (definition alternate).

Alternate definitionA mark 'X' in the Not Covered column indicates the service/code is excluded from coverage in this Colorado list.

DisplayedShown as 'Not Covered = X' alongside the code description.

ConsequenceClaims for services marked Not Covered = X are not payable under the listed scope.

inv-120: Coverage may vary by plan type disclaimer (alternate).

Plan-type disclaimerCoverage may vary by plan type — confirm the code status for the member's specific plan.

Update scheduleListings are updated quarterly; always reference the current roster date (e.g., As of 03/26/26).

Pharmacy exceptionsImmunizations, injectable drugs, and specialty medications are excluded and managed via Pharmacy links.

inv-121: Molecular pathology code ranges note (usage context).

ContextMolecular pathology CPT ranges (e.g., 81400-81408) correspond to increasing complexity/extent of analysis and are used in the list to denote laboratory procedure levels.

InterpretationThese ranges are presented alongside Preauthorization/Not Covered notations to guide authorization for molecular testing.

Provider noteRefer to per-code descriptions for specific analytic scope when determining preauthorization needs.

inv-122: Coverage lists updated quarterly disclaimer (repeated).

Quarterly updatesCoverage lists are updated quarterly; check the most recent roster for current statuses.

Scope reminderImmunizations, injectables and specialty medications are not included in these lists; use Pharmacy resources for those items.

Plan variabilityCoverage may vary by plan type — entries apply specifically to Colorado Medicare listings.

inv-123: Genomic panel description — gene counts and analytic scopes.

Panel descriptionGenomic sequencing panels and gene-expression/profile panels are described by gene counts and analytic scope (sequence variants, copy number, rearrangements, RNA analysis, microsatellite instability, tumor mutation burden).

ExamplesCodes such as 81418 require testing of at least 6 genes; 81432 requires at least 14 genes — these gene-count requirements are shown in the list.

ImplicationGene count and analytic scope influence which CPT panel code is appropriate and whether preauthorization is required.

inv-124: Disclaimer (additional).

Additional disclaimerThe roster snapshot is state-specific (Colorado) and may not represent other jurisdictions; consult Pharmacy for excluded items.

Update cadenceListings are maintained on a quarterly schedule.

Plan variationCoverage may vary by plan type — verify for member-specific applicability.

inv-125: Preauthorization Required (duplicate reference).

Duplicate referencePreauthorization Required = X denotes codes requiring prior authorization (reproduced across multiple sections).

Provider actionFollow SelectHealth prior authorization processes when codes are so designated.

NotationAn 'X' in the Preauthorization column is the consistent visual marker in the document.

inv-126: Not Covered (duplicate reference).

Duplicate referenceNot Covered = X is used repeatedly across the list to indicate excluded services for Colorado Medicare.

ActionProviders should not expect reimbursement for codes marked Not Covered = X under the listed scope.

VerificationConfirm member plan applicability and potential exceptions prior to service delivery.

inv-127: Disclaimer / update frequency (additional).

Update frequency noteLists are updated quarterly; verify the 'As of' date on the roster (e.g., 03/26/26) for currency.

Coverage variabilityCoverage may differ by plan type; this roster is specific to Colorado Medicare listings.

Pharmacy exclusionsImmunizations, injectable drugs, and specialty medications are excluded and handled via Pharmacy links.

inv-128: Not Covered / Preauthorization indicators (general).

General useDocument entries include explicit 'Not Covered = X' or 'Preauthorization Required = X' indicators to show coverage status for each code.

InterpretationAn 'X' denotes the active designation; hyphen or blank indicates not applicable or no requirement.

Provider checkReview the per-code indicators before delivering services or submitting claims.

inv-129: Not Covered (definition repeated).

Repeated definitionNot Covered = X flags a code as excluded from coverage under this Colorado Medicare list.

Displayed asShown as 'X' in the Not Covered column next to the code description.

Provider implicationClaims for Not Covered codes are not payable under the listed scope without exception.

inv-130: Preauthorization Required (definition repeated).

Repeated definitionPreauthorization Required = X indicates prior authorization is required for the listed code (repeated across the roster).

DisplayMarked as 'X' in the Preauthorization column; hyphen or blank indicates no prior authorization required.

Provider actionObtain authorization per SelectHealth procedures for codes so marked to reduce denial risk.

inv-131: Time-based E/M selection — telehealth/E/M total time thresholds described.

Time-based E/M selectionSeveral telehealth/E/M codes in the list specify minimum total time on the date of the encounter required for correct code selection (examples: 10, 15, 20, 30, 40, 45, 60 minutes depending on code).

ExamplesCodes 98000–98003 and 98004–98007 include minute thresholds (e.g., 15, 30, 45, 60 minutes) for new and established patient audio-video visits.

Provider noteWhen using total time for E/M selection, ensure documented encounter time meets or exceeds the listed threshold for the chosen code.

inv-132: Disclaimer (final).

Final disclaimerCoverage may vary by plan type; lists are updated quarterly; immunizations/injectable/specialty medications are excluded and managed via Pharmacy.

Snapshot dateThe document displays an 'As of' date for the roster snapshot (e.g., 03/26/26).

Provider actionAlways verify the member's plan and the current roster before providing services or submitting authorization requests.

Coding Lists Update Frequency and Panel Rules

inv-55: update_frequency — updated quarterly.

Update cadenceUpdated quarterly.

VerificationCheck the roster's 'As of' date to confirm currentness before action.

Pharmacy noteImmunizations, injectable drugs, and specialty medications are not represented in these lists; see Pharmacy resources.

inv-56: update_frequency — quarterly.

Update cadenceQuarterly.

ApplicabilityApplies to the Colorado Medicare code roster; confirm for member's plan line-of-business.

Provider reminderUse the latest quarterly roster when determining preauthorization requirements or coverage exclusions.

inv-57: update_frequency — quarterly.

Update cadenceQuarterly updates are performed on these coding lists.

Document noteThe roster's disclaimer repeats update frequency and plan-variability guidance throughout the document.

Provider actionConfirm the quarter's roster before initiating authorizations or delivering services.

inv-58: Quantity groupings for drug class tests — many drug-class CPT codes listed with quantity ranges.

Quantity groupingsMany toxicology/drug-class CPT codes are listed with quantity groupings (e.g., 1-2, 3-5, 6+), each designation showing coverage status in the roster.

ExamplesEntries such as 80335–80377 indicate drug/metabolite class groupings with Not Covered or Preauthorization statuses by quantity bucket.

Provider implicationCheck the specific quantity bucket for the drug-class test code to determine coverage stance.

inv-59: update_frequency — codes updated quarterly (alternate).

Codes updated quarterlyCodes and status indicators in the roster are updated quarterly.

Cross-checkConfirm the 'As of' date on each page segment to ensure you are using the current quarterly roster.

ExclusionsPharmacy-managed items are excluded despite the quarterly update schedule.

inv-60: Panel gene count requirement example — some panels specify minimum gene counts (e.g., 81418 must include >=6 genes; 81432 >=14 genes).

Gene-count examplesSome panels specify minimum gene counts: e.g., 81418 must include at least 6 genes; 81432 must include at least 14 genes.

Panel mappingGene-count requirements are stated in the per-code descriptions to define the appropriate CPT panel code.

Authorization impactGene-count thresholds help determine which panel code applies and whether preauthorization is required.

inv-61: Gene count grouping — panels described by gene count buckets which may influence code selection.

Grouping by gene countPanels are described by gene-count buckets (e.g., 5–50 genes; >=51 genes) which influence the selected CPT code and authorization requirements.

ExamplesCodes such as 81450–81456 reflect panels defined by gene-count ranges and analytic scope.

Provider noteVerify the panel's reported gene count and analytic components to select the correct CPT code and check preauthorization status.

inv-62: time thresholds for telehealth E/M codes — specified minute thresholds for each code.

Time thresholdsTelehealth E/M codes specify minute thresholds for total time on date of encounter used to select the correct code (examples: 10, 15, 20, 30, 40, 45, 60 minutes depending on code).

ExamplesCodes 98000–98003 for new patients and 98004–98008 for established patients list specific minute minimums (e.g., 15, 30, 45, 60 minutes).

DocumentationWhen using total time for code selection, document the encounter time to meet or exceed the stated threshold.

inv-63: Time-based E/M total time thresholds described (examples).

Total time thresholdsMultiple codes require minimum total time on the date of the encounter for correct code selection (examples across the roster: 10, 15, 20, 30, 40, 45, 60 minutes).

Provider guidanceEnsure medical record documents total time spent and the medical decision making or history/exam components as applicable.

Telehealth examplesSeveral synchronous audio-video and audio-only visit codes include explicit minute thresholds in their descriptions.

inv-64: update_frequency — quarterly (final).

Update cadenceQuarterly.

Confirm currentnessAlways check the roster 'As of' date for the current quarterly snapshot before acting on code statuses.

Excluded itemsPharmacy-managed immunizations/injectables/specialty meds are not included despite the quarterly update schedule.

Policy Summary

PayerSelectHealth

PolicyMedicare codes not covered or requiring preauthorization - Colorado

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 26, 2026

Next Review DateN/A

Key ActionObtain prior authorization for any CPT/HCPCS codes marked as Preauthorization Required (X) before providing the service.

SourceLink

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