Anthem Blue Cross and Blue Shield Nevada prior authorization, page 14
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 |
|---|---|---|
| 31259 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus | Nevada Prior Authorization List, Pg 32 Original policy |
| 31267 | Nasal/Sinus Endoscopy, Surgical, W/Maxillary Antrostomy; W/Maxillary Tissue Removal | Nevada Prior Authorization List, Pg 33 Original policy |
| 31276 | Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed | Nevada Prior Authorization List, Pg 33 Original policy |
| 31287 | Nasal/Sinus Endoscopy, Surgical, W/Sphenoidotomy | Nevada Prior Authorization List, Pg 33 Original policy |
| 31288 | Nasal/Sinus Endoscopy, Surgical, W/Sphenoidotomy; W/Tissue Removal, Sphenoid Sinus | Nevada Prior Authorization List, Pg 33 Original policy |
| 31295 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa | Nevada Prior Authorization List, Pg 33 Original policy |
| 31296 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium | Nevada Prior Authorization List, Pg 33 Original policy |
| 31297 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium | Nevada Prior Authorization List, Pg 33 Original policy |
| 31298 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia | Nevada Prior Authorization List, Pg 33 Original policy |
| 31525 | Laryngoscopy Direct, W/Wo Tracheoscopy; Dx, Except Newborn | Nevada Prior Authorization List, Pg 33 Original policy |
| 31526 | Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescope | Nevada Prior Authorization List, Pg 33 Original policy |
| 31528 | Laryngoscopy Direct, W/Wo Tracheoscopy; W/Dilatation, Initial | Nevada Prior Authorization List, Pg 33 Original policy |
| 31529 | Laryngoscopy Direct, W/Wo Tracheoscopy; W/Dilatation, Subsequent | Nevada Prior Authorization List, Pg 33 Original policy |
| 31530 | Laryngoscopy, Direct, Operative, W/Fb Removal | Nevada Prior Authorization List, Pg 33 Original policy |
| 31535 | Laryngoscopy, Direct, Operative, W/Bx | Nevada Prior Authorization List, Pg 33 Original policy |
| 31536 | Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope | Nevada Prior Authorization List, Pg 33 Original policy |
| 31540 | Laryngoscopy, Direct, Operative, W/Excision, Tumor/Stripping Vocal Cords/Epiglottis | Nevada Prior Authorization List, Pg 33 Original policy |
| 31541 | Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating mi | Nevada Prior Authorization List, Pg 33 Original policy |
| 31545 | Laryngoscopy, Direct, W Operating Micro/Telescope, W Removal Vocal Cord Lesions; Reconstruction W Local Tissue | Nevada Prior Authorization List, Pg 33 Original policy |
| 31570 | Laryngoscopy, Direct, W/Injection Into Vocal Cord(S), Therapeutic | Nevada Prior Authorization List, Pg 33 Original policy |
| 31571 | Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope | Nevada Prior Authorization List, Pg 33 Original policy |
| 31574 | Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral | Nevada Prior Authorization List, Pg 33 Original policy |
| 31575 | Laryngoscopy, flexible; diagnostic | Nevada Prior Authorization List, Pg 33 Original policy |
| 31576 | Laryngoscopy, flexible; with biopsy(ies) | Nevada Prior Authorization List, Pg 33 Original policy |
| 31578 | Laryngoscopy, flexible; with removal of lesion(s), non-laser | Nevada Prior Authorization List, Pg 33 Original policy |
| 31591 | Laryngoplasty; medialization, unilateral | Nevada Prior Authorization List, Pg 33 Original policy |
| 31622 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when pe | Nevada Prior Authorization List, Pg 33 Original policy |
| 31623 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings | Nevada Prior Authorization List, Pg 33 Original policy |
| 31624 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage | Nevada Prior Authorization List, Pg 33 Original policy |
| 31625 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy | Nevada Prior Authorization List, Pg 33 Original policy |
| 31628 | Bronchoscopy, Rigid/Flexible; W/Transbronchial Lung Bx | Nevada Prior Authorization List, Pg 33 Original policy |
| 31643 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intr | Nevada Prior Authorization List, Pg 33 Original policy |
| 31652 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg | Nevada Prior Authorization List, Pg 34 Original policy |
| 31660 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe | Nevada Prior Authorization List, Pg 34 Original policy |
| 31661 | Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes | Nevada Prior Authorization List, Pg 34 Original policy |
| 31820 | Surgical Closure Tracheostomy/Fistula; W/O Plastic Repair | Nevada Prior Authorization List, Pg 34 Original policy |
| 32408 | Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed | Nevada Prior Authorization List, Pg 34 Original policy |
| 32555 | Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance | Nevada Prior Authorization List, Pg 34 Original policy |
| 32557 | Pleural drainage, percutaneous, with insertion of indwelling catheter; with imaging guidance | Nevada Prior Authorization List, Pg 34 Original policy |
| 32701 | Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment | Nevada Prior Authorization List, Pg 34 Original policy |
| 32850 | Donor pneumonectomy(s) (including cold preservation), from cadaver donor | Nevada Prior Authorization List, Pg 34 Original policy |
| 32851 | Lung Transplant, Single; W/O Cardiopulmonary Bypass | Nevada Prior Authorization List, Pg 34 Original policy |
| 32852 | Lung Transplant, Single; W/Cardiopulmonary Bypass | Nevada Prior Authorization List, Pg 34 Original policy |
| 32853 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/O Cardiopulmonary Bypass | Nevada Prior Authorization List, Pg 34 Original policy |
| 32854 | Lung Transplant, Double (Bilat Sequential/En Bloc); W/Cardiopulmonary Bypass | Nevada Prior Authorization List, Pg 34 Original policy |
| 32855 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Unilateral | Nevada Prior Authorization List, Pg 34 Original policy |
| 32856 | Backbench Standard Preparation Of Cadaver Donor Lung Allograft; Bilateral | Nevada Prior Authorization List, Pg 34 Original policy |
| 32994 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Nevada Prior Authorization List, Pg 34 Original policy |
| 32998 | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Nevada Prior Authorization List, Pg 34 Original policy |
| 33140 | Transmyocardial Laser Revascularization, By Thoracotomy | Nevada Prior Authorization List, Pg 34 Original policy |