Anthem Blue Cross and Blue Shield Nevada prior authorization, page 15
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 |
|---|---|---|
| 33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | Nevada Prior Authorization List, Pg 34 Original policy |
| 33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | Nevada Prior Authorization List, Pg 34 Original policy |
| 33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | Nevada Prior Authorization List, Pg 34 Original policy |
| 33212 | Insertion of pacemaker pulse generator only; with existing single lead | Nevada Prior Authorization List, Pg 34 Original policy |
| 33213 | Insertion of pacemaker pulse generator only; with existing dual leads | Nevada Prior Authorization List, Pg 34 Original policy |
| 33214 | Repositioning, Previously Implanted Transvenous Electrode/Pacing Cardiovert- Defib Electrode | Nevada Prior Authorization List, Pg 35 Original policy |
| 33215 | Repositioning of Previously Implanted Transvenous Pacemaker or Pacing Cardioverter-Defibrillator Electrode | Nevada Prior Authorization List, Pg 35 Original policy |
| 33216 | Insertion of a single transvenous electrode, permanent pacemaker or cardioverter-defibrillator | Nevada Prior Authorization List, Pg 35 Original policy |
| 33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or cardioverter- defibrillator | Nevada Prior Authorization List, Pg 35 Original policy |
| 33218 | Repair of single transvenous electrode, permanent pacemaker or pacing cardioverter-defibrillator | Nevada Prior Authorization List, Pg 35 Original policy |
| 33220 | Repair of 2 transvenous electrodes for permanent pacemaker or pacing cardioverter-defibrillator | Nevada Prior Authorization List, Pg 35 Original policy |
| 33222 | Relocation of skin pocket for pacemaker | Nevada Prior Authorization List, Pg 35 Original policy |
| 33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter- defibrillator pulse ge | Nevada Prior Authorization List, Pg 35 Original policy |
| 33226 | Repositioning Of Previously Implanted Cardiac Venous System (Left Ventricular) Electrode (Including Removal, Insertion And/Or Replacement Of Existing Generator) | Nevada Prior Authorization List, Pg 35 Original policy |
| 33227 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Single Lead System | Nevada Prior Authorization List, Pg 35 Original policy |
| 33228 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Dual Lead System | Nevada Prior Authorization List, Pg 35 Original policy |
| 33229 | Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Multiple Lead System | Nevada Prior Authorization List, Pg 35 Original policy |
| 33230 | Insertion Of Pacing Cardioverter-Defibrillator Pulse Generator Only; With Existing Dual Leads | Nevada Prior Authorization List, Pg 35 Original policy |
| 33231 | Insertion Of Pacing Cardioverter-Defibrillator Pulse Generator Only; With Existing Multiple Leads | Nevada Prior Authorization List, Pg 35 Original policy |
| 33233 | Removal of permanent pacemaker pulse generator only | Nevada Prior Authorization List, Pg 35 Original policy |
| 33234 | Removal, Transvenous Pacemaker Electrode(S); Single Lead System, Atrial/Ventricular | Nevada Prior Authorization List, Pg 35 Original policy |
| 33235 | Removal, Transvenous Pacemaker Electrode(S); Dual Lead System | Nevada Prior Authorization List, Pg 35 Original policy |
| 33240 | Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead | Nevada Prior Authorization List, Pg 36 Original policy |
| 33249 | Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber | Nevada Prior Authorization List, Pg 36 Original policy |
| 33263 | Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Dual Lead System | Nevada Prior Authorization List, Pg 36 Original policy |
| 33264 | Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Multiple Lead System | Nevada Prior Authorization List, Pg 36 Original policy |
| 33267 | Exclusion of left atrial appendage, open, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | Nevada Prior Authorization List, Pg 36 Original policy |
| 33269 | Exclusion of left atrial appendage, thoracoscopic, any method (eg, excision, isolation via stapling, oversewing, ligation, plication, clip) | Nevada Prior Authorization List, Pg 36 Original policy |
| 33270 | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of a | Nevada Prior Authorization List, Pg 36 Original policy |
| 33271 | Insertion of subcutaneous implantable defibrillator electrode | Nevada Prior Authorization List, Pg 36 Original policy |
| 33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, fe | Nevada Prior Authorization List, Pg 36 Original policy |
| 33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) | Nevada Prior Authorization List, Pg 36 Original policy |
| 33276 | Insertion of phrenic nerve stimulator system (pulse generator and stimulating lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial ana | Nevada Prior Authorization List, Pg 36 Original policy |
| 33278 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; system, including pulse generat | Nevada Prior Authorization List, Pg 36 Original policy |
| 33279 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous stimulation or sens | Nevada Prior Authorization List, Pg 36 Original policy |
| 33280 | Removal of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator only | Nevada Prior Authorization List, Pg 36 Original policy |
| 33281 | Repositioning of phrenic nerve stimulator transvenous lead(s) | Nevada Prior Authorization List, Pg 36 Original policy |
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | Nevada Prior Authorization List, Pg 36 Original policy |
| 33287 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; pulse generator | Nevada Prior Authorization List, Pg 36 Original policy |
| 33288 | Removal and replacement of phrenic nerve stimulator, including vessel catheterization, all imaging guidance, and interrogation and programming, when performed; transvenous sti | Nevada Prior Authorization List, Pg 36 Original policy |
| 33289 | Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart c | Nevada Prior Authorization List, Pg 37 Original policy |
| 33340 | Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angio | Nevada Prior Authorization List, Pg 37 Original policy |
| 33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | Nevada Prior Authorization List, Pg 37 Original policy |
| 33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | Nevada Prior Authorization List, Pg 37 Original policy |
| 33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | Nevada Prior Authorization List, Pg 37 Original policy |
| 33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | Nevada Prior Authorization List, Pg 37 Original policy |
| 33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) | Nevada Prior Authorization List, Pg 37 Original policy |
| 33366 | Transcatheter aortic valve replacement (tavr/tavi) with prosthetic valve; transapical exposure (eg, left thoracotomy) | Nevada Prior Authorization List, Pg 37 Original policy |
| 33418 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis | Nevada Prior Authorization List, Pg 37 Original policy |
| 33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | Nevada Prior Authorization List, Pg 37 Original policy |