Anthem Blue Cross and Blue Shield Nevada prior authorization, page 13
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
| Code | Description | Source |
|---|---|---|
| 29883 | Arthroscopy, Knee, Surgical; W/Meniscus Repair, Medial & Lateral | Nevada Prior Authorization List, Pg 30 Original policy |
| 29884 | Arthroscopy, Knee, Surgical; W/Lysis, Adhesions, W/Wo Manipulation (Sep Proc) | Nevada Prior Authorization List, Pg 30 Original policy |
| 29885 | Arthroscopy, Knee, Surgical; Drill, Osteochondritis Dissecans W/Bone Graft, W/Wo Int/Ext Fixation | Nevada Prior Authorization List, Pg 31 Original policy |
| 29886 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion | Nevada Prior Authorization List, Pg 31 Original policy |
| 29887 | Arthroscopy, Knee, Surgical; Drilling, Intact Osteochondritis Dissecans Lesion W/Int Fixation | Nevada Prior Authorization List, Pg 31 Original policy |
| 29888 | Arthroscopically Aided Anterior Cruciate Ligament Repair/Augmentation/Reconstruction | Nevada Prior Authorization List, Pg 31 Original policy |
| 29889 | Arthroscopically Aided Posterior Cruciate Ligament Repair/Augmentation/Reconstruction | Nevada Prior Authorization List, Pg 31 Original policy |
| 29892 | Arthroscopically Aided Repair, Osteochondritis/Talar Dome Fx/Tibial Plafond Fx | Nevada Prior Authorization List, Pg 31 Original policy |
| 29914 | Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion) | Nevada Prior Authorization List, Pg 31 Original policy |
| 29915 | Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment of pincer lesion) | Nevada Prior Authorization List, Pg 31 Original policy |
| 29916 | Arthroscopy, hip, surgical; with labral repair | Nevada Prior Authorization List, Pg 31 Original policy |
| 30100 | Bx, Intranasal | Nevada Prior Authorization List, Pg 31 Original policy |
| 30115 | Excision, Nasal Polyp(S), Extensive | Nevada Prior Authorization List, Pg 31 Original policy |
| 30117 | Excision/Destruction, Intranasal Lesion; Int Approach | Nevada Prior Authorization List, Pg 31 Original policy |
| 30118 | Excision/Destruction, Intranasal Lesion; Ext Approach | Nevada Prior Authorization List, Pg 31 Original policy |
| 30120 | Excision/Surgical Planing, Skin, Nose, Rhinophyma | Nevada Prior Authorization List, Pg 31 Original policy |
| 30130 | Excision inferior turbinate, partial or complete, any method | Nevada Prior Authorization List, Pg 31 Original policy |
| 30140 | Submucous resection inferior turbinate, partial or complete, any method | Nevada Prior Authorization List, Pg 31 Original policy |
| 30220 | Insertion, Nasal Septal Prosthesis (Button) | Nevada Prior Authorization List, Pg 31 Original policy |
| 30310 | Removal Fb, Intranasal; Requiring General Anesthesia | Nevada Prior Authorization List, Pg 31 Original policy |
| 30400 | Rhinoplasty, Primary; Lateral & Alar Cartilages &/Or Elevation, Nasal Tip | Nevada Prior Authorization List, Pg 31 Original policy |
| 30410 | Rhinoplasty, Primary; Complete, Ext Parts W/Bony Pyramid, Lat & Alar Cartilages &/Or Elev Nasal Tip | Nevada Prior Authorization List, Pg 31 Original policy |
| 30420 | Rhinoplasty, Primary; W/Major Septal Repair | Nevada Prior Authorization List, Pg 32 Original policy |
| 30430 | Rhinoplasty, Secondary; Minor Revision (Small Amount, Nasal Tip Work) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30435 | Rhinoplasty, Secondary; Intermediate Revision (Bony Work W/Osteotomies) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30450 | Rhinoplasty, Secondary; Major Revision (Nasal Tip Work & Osteotomies) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30468 | Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30469 | Repair of nasal valve collapse with low energy, temperature-controlled (ie, radiofrequency) subcutaneous/submucosal | Nevada Prior Authorization List, Pg 32 Original policy |
| 30520 | Septoplasty/Submucous Resection W/Wo Cartilage Scoring/Contouring/Graft | Nevada Prior Authorization List, Pg 32 Original policy |
| 30580 | Repair Fistula; Oromaxillary (Combine W/31030 If Antrotomy Is Included) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30620 | Septal/Other Intranasal Dermatoplasty (Does Not Include Obtaining Graft) | Nevada Prior Authorization List, Pg 32 Original policy |
| 30630 | Repair Nasal Septal Perforations | Nevada Prior Authorization List, Pg 32 Original policy |
| 30801 | Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ab | Nevada Prior Authorization List, Pg 32 Original policy |
| 30802 | Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ab | Nevada Prior Authorization List, Pg 32 Original policy |
| 30901 | Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery &/Or Packing) Any Method | Nevada Prior Authorization List, Pg 32 Original policy |
| 30903 | Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery &/Or Packing) Any Method | Nevada Prior Authorization List, Pg 32 Original policy |
| 30930 | Fracture nasal inferior turbinate(s), therapeutic | Nevada Prior Authorization List, Pg 32 Original policy |
| 31020 | Sinusotomy, Maxillary (Antrotomy); Intranasal | Nevada Prior Authorization List, Pg 32 Original policy |
| 31030 | Sinusotomy, Maxillary (Antrotomy); Radical (Caldwell-Luc) W/O Removal, Antrochoanal Polyps | Nevada Prior Authorization List, Pg 32 Original policy |
| 31032 | Sinusotomy, Maxillary (Antrotomy); Radical (Caldwell-Luc) W/Removal, Antrochoanal Polyps | Nevada Prior Authorization List, Pg 32 Original policy |
| 31200 | Ethmoidectomy; Intranasal, Anterior | Nevada Prior Authorization List, Pg 32 Original policy |
| 31237 | Nasal/Sinus Endoscopy, Surgical; W/Bx, Polypectomy/Debridement (Sep Proc) | Nevada Prior Authorization List, Pg 32 Original policy |
| 31238 | Nasal/Sinus Endoscopy, Surgical; W/Control, Nasal Hemorrhage | Nevada Prior Authorization List, Pg 32 Original policy |
| 31242 | Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve | Nevada Prior Authorization List, Pg 32 Original policy |
| 31243 | Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve | Nevada Prior Authorization List, Pg 32 Original policy |
| 31253 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when perfor | Nevada Prior Authorization List, Pg 32 Original policy |
| 31254 | Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) | Nevada Prior Authorization List, Pg 32 Original policy |
| 31255 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) | Nevada Prior Authorization List, Pg 32 Original policy |
| 31256 | Nasal/Sinus Endoscopy, Surgical, W/Maxillary Antrostomy | Nevada Prior Authorization List, Pg 32 Original policy |
| 31257 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy | Nevada Prior Authorization List, Pg 32 Original policy |