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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 10

CPT code lookup

Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.

Prior authorization codes

Prior authorization codes
CodeDescriptionSource
24201Removal, Fb, Upper Arm/Elbow Area; Deep (Subfascial/Im)Nevada Prior Authorization List, Pg 22 Original policy
24300Manipulation, Elbow, Under AnesthesiaNevada Prior Authorization List, Pg 22 Original policy
24310Tenotomy, Open, Elbow To Shoulder, Each TendonNevada Prior Authorization List, Pg 22 Original policy
24340Tenodesis, Biceps Tendon At Elbow (Sep Proc)Nevada Prior Authorization List, Pg 22 Original policy
24357Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneousNevada Prior Authorization List, Pg 22 Original policy
24358Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or boNevada Prior Authorization List, Pg 22 Original policy
24366Arthroplasty, Radial Head; W/ImplantNevada Prior Authorization List, Pg 22 Original policy
24515Open Treatment, Humeral Shaft Fx W/Plate/Screws, W/Wo CerclageNevada Prior Authorization List, Pg 22 Original policy
24586Open Treatment, Periarticular Fx/Dislocation, ElbowNevada Prior Authorization List, Pg 22 Original policy
24665Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performedNevada Prior Authorization List, Pg 22 Original policy
24666Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; withNevada Prior Authorization List, Pg 22 Original policy
25000Incision, Extensor Tendon Sheath, WristNevada Prior Authorization List, Pg 22 Original policy
25071Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greaterNevada Prior Authorization List, Pg 22 Original policy
25073Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); 3 cm or greaterNevada Prior Authorization List, Pg 22 Original policy
25075Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cmNevada Prior Authorization List, Pg 22 Original policy
25076Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); less than 3 cmNevada Prior Authorization List, Pg 22 Original policy
25085Capsulotomy, WristNevada Prior Authorization List, Pg 22 Original policy
25105Arthrotomy, Wrist Joint; W/SynovectomyNevada Prior Authorization List, Pg 22 Original policy
25107Arthrotomy, Distal Radioulnar Joint W/Repair, Triangular Cartilage, ComplexNevada Prior Authorization List, Pg 22 Original policy
25109Excision of tendon, forearm and/or wrist, flexor or extensor, eachNevada Prior Authorization List, Pg 22 Original policy
25110Excision, Lesion, Tendon Sheath, Forearm &/Or WristNevada Prior Authorization List, Pg 22 Original policy
25111Excision, Ganglion, Wrist (Dorsal/Volar); PrimaryNevada Prior Authorization List, Pg 22 Original policy
25112Excision, Ganglion, Wrist (Dorsal/Volar); RecurrentNevada Prior Authorization List, Pg 22 Original policy
25259Manipulation, Wrist, Under AnesthesiaNevada Prior Authorization List, Pg 22 Original policy
25605Closed Treatment, Distal Radial Fx/Epiphyseal Separation; W/ManipulationNevada Prior Authorization List, Pg 23 Original policy
25606Percutaneous skeletal fixation of distal radial fracture or epiphyseal separationNevada Prior Authorization List, Pg 23 Original policy
25607Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixationNevada Prior Authorization List, Pg 23 Original policy
25608Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragmentsNevada Prior Authorization List, Pg 23 Original policy
25609with internal fixation of 3 or more fragmentsNevada Prior Authorization List, Pg 23 Original policy
25624Closed Treatment, Carpal Scaphoid (Navicular) Fx; W/ManipulationNevada Prior Authorization List, Pg 23 Original policy
25628Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performedNevada Prior Authorization List, Pg 23 Original policy
25635Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, each boneNevada Prior Authorization List, Pg 23 Original policy
25645Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each boneNevada Prior Authorization List, Pg 23 Original policy
26160Excision, Lesion, Tendon Sheath/Joint Capsule, Hand/FingerNevada Prior Authorization List, Pg 23 Original policy
26180Excision of tendon, finger, flexor or extensor, each tendonNevada Prior Authorization List, Pg 23 Original policy
26200Excision/Curettage, Bone Cyst/Benign Tumor, MetacarpalNevada Prior Authorization List, Pg 23 Original policy
26210Excision/Curettage, Bone Cyst/Benign Tumor, Phalanx, FingerNevada Prior Authorization List, Pg 23 Original policy
26340Manipulation, Finger Joint, Under Anesthesia, Each JointNevada Prior Authorization List, Pg 23 Original policy
27006Tenotomy, Abductors &/Or Extensor(S), Hip, Open (Sep Proc)Nevada Prior Authorization List, Pg 23 Original policy
27043Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greaterNevada Prior Authorization List, Pg 23 Original policy
27045Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); 5 cm or greaterNevada Prior Authorization List, Pg 23 Original policy
27047Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cmNevada Prior Authorization List, Pg 23 Original policy
27048Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cmNevada Prior Authorization List, Pg 23 Original policy
27062Excision; Trochanteric Bursa/CalcificationNevada Prior Authorization List, Pg 23 Original policy
27096Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performedNevada Prior Authorization List, Pg 23 Original policy
27120AcetabuloplastyNevada Prior Authorization List, Pg 23 Original policy
27122Acetabuloplasty; Resection, Femoral HeadNevada Prior Authorization List, Pg 23 Original policy
27125Hemiarthroplasty, Hip, PartialNevada Prior Authorization List, Pg 23 Original policy
27130Arthroplasty, Acetabular/Proximal Femoral Prosthetic Replacement, W/Wo Autograft/AllograftNevada Prior Authorization List, Pg 24 Original policy
27132Conversion, Previous Hip Surgery To Total Hip Arthroplasty, W/Wo Autograft/AllograftNevada Prior Authorization List, Pg 24 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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