Appendix B: Designated Procedures for Centers of Expertise

For designated procedures, the Plan has identified Centers of Expertise. The specific procedures that are designated are listed below.

Cardiothoracic Procedures

Nonemergency surgical treatment for any of the following conditions:

  • Aortic aneurysm (chest or abdomen)
  • Congenital heart defect
  • Coronary atherosclerosis
  • Lung disease
  • Valvular heart disease

Designated cardiothoracic procedures by Current Procedural Terminology® (CPT) code:

  • 32100-32540
  • 32601-32674
  • 33015-33203
  • 33250-33266
  • 33300-33945
  • 33975-33999
  • 34800-34848
  • 35001-35152

Note: Following are common cardiothoracic procedures that are not Centers-of-Expertise designated procedures (but do require preauthorization): Pacemaker placement, cardiac catheterization with or without coronary stent placement, implantable defibrillator placement, peripheral artery bypass, electrophysiology studies, percutaneous intracardiac ablation, cardiac stress testing, endoscopic or percutaneous lung biopsy.

Spinal Procedures

Nonemergency surgical treatment for any of the following conditions:

  • Back or neck pain
  • Spinal cord injury or compression
  • Scoliosis
  • Disease or injury of the vertebrae, discs or spinal nerves

Designated spinal procedures by CPT code:

  • 22010-22505
  • 22532-22899

Note: Following are common spinal procedures that are not Centers-of-Expertise designated procedures (but do require preauthorization): Percutaneous neurolysis, neurostimulator trial/implantation, percutaneous vertebroplasty/kyphoplasty/annuloplasty.

Cochlear (Ear) Implants

Cochlear implant to treat profound bilateral sensorineural hearing loss (CPT code 69930)