Anthem Blue Cross and Blue Shield Nevada prior authorization, page 16
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 |
|---|---|---|
| 33927 | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | Nevada Prior Authorization List, Pg 37 Original policy |
| 33928 | Removal and replacement of total replacement heart system (artificial heart) | Nevada Prior Authorization List, Pg 37 Original policy |
| 33930 | Donor Cardiectomy-Pneumonectomy, W/Preparation & Maintenance, Allograft | Nevada Prior Authorization List, Pg 37 Original policy |
| 33933 | Backbench Standard Preparation Of Cadaver Donor Heart/Lung Allograft | Nevada Prior Authorization List, Pg 37 Original policy |
| 33935 | Heart-Lung Transplant W/Recipient Cardiectomy-Pneumonectomy | Nevada Prior Authorization List, Pg 37 Original policy |
| 33940 | Donor Cardiectomy, W/Preparation & Maintenance, Allograft | Nevada Prior Authorization List, Pg 37 Original policy |
| 33944 | Backbench Standard Preparation Of Cadaver Donor Heart Allograft | Nevada Prior Authorization List, Pg 37 Original policy |
| 33945 | Heart Transplant, W/Wo Recipient Cardiectomy | Nevada Prior Authorization List, Pg 37 Original policy |
| 33975 | Insertion, Ventricular Assist Device; Extracorporeal, Single Ventricle | Nevada Prior Authorization List, Pg 37 Original policy |
| 33976 | Insertion, Ventricular Assist Device; Extracorporeal, Biventricular | Nevada Prior Authorization List, Pg 37 Original policy |
| 33979 | Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle | Nevada Prior Authorization List, Pg 37 Original policy |
| 33981 | Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump | Nevada Prior Authorization List, Pg 37 Original policy |
| 33982 | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary | Nevada Prior Authorization List, Pg 37 Original policy |
| 33983 | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary byp | Nevada Prior Authorization List, Pg 37 Original policy |
| 33990 | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only | Nevada Prior Authorization List, Pg 38 Original policy |
| 33991 | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal punc | Nevada Prior Authorization List, Pg 38 Original policy |
| 33993 | Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion | Nevada Prior Authorization List, Pg 38 Original policy |
| 33995 | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only | Nevada Prior Authorization List, Pg 38 Original policy |
| 36260 | Insertion, Implantable Intra-Arterial Infusion Pump | Nevada Prior Authorization List, Pg 38 Original policy |
| 36261 | Revision, Implanted Intra-Arterial Infusion Pump | Nevada Prior Authorization List, Pg 38 Original policy |
| 36465 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; singl | Nevada Prior Authorization List, Pg 38 Original policy |
| 36466 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multi | Nevada Prior Authorization List, Pg 38 Original policy |
| 36468 | Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk | Nevada Prior Authorization List, Pg 38 Original policy |
| 36470 | Injection of sclerosant; single incompetent vein (other than telangiectasia) | Nevada Prior Authorization List, Pg 38 Original policy |
| 36471 | Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg | Nevada Prior Authorization List, Pg 38 Original policy |
| 36473 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated | Nevada Prior Authorization List, Pg 38 Original policy |
| 36475 | Endovenous Ablation Therapy Of Incompetent Vein, Extremity, Percutaneous, Radiofrequency; First Vein Treated | Nevada Prior Authorization List, Pg 38 Original policy |
| 36478 | Endovenous Ablation Therapy Of Incompetent Vein, Extremity, Percutaneous, Laser; First Vein Treated | Nevada Prior Authorization List, Pg 38 Original policy |
| 36482 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all | Nevada Prior Authorization List, Pg 38 Original policy |
| 36511 | Therapeutic Apheresis; White Blood Cells | Nevada Prior Authorization List, Pg 38 Original policy |
| 36512 | Therapeutic Apheresis; Red Blood Cells | Nevada Prior Authorization List, Pg 38 Original policy |
| 36513 | Therapeutic Apheresis; Platelets | Nevada Prior Authorization List, Pg 38 Original policy |
| 36514 | Therapeutic Apheresis; Plasma Pheresis | Nevada Prior Authorization List, Pg 38 Original policy |
| 36516 | Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion | Nevada Prior Authorization List, Pg 38 Original policy |
| 36556 | Insertion of Non-Tunneled Centrally Inserted Central Venous Catheter; Age 5 Years or Older | Nevada Prior Authorization List, Pg 38 Original policy |
| 36563 | Insertion of Tunneled Centrally Inserted Central Venous Access Device with Subcutaneous Pump | Nevada Prior Authorization List, Pg 39 Original policy |
| 36571 | Insertion of Peripherally Inserted Central Venous Access Device, with Subcutaneous Port; Age 5 Years or Older | Nevada Prior Authorization List, Pg 39 Original policy |
| 36581 | Replacement, Complete, of a Tunneled Centrally Inserted Central Venous Catheter, wo Sq Port or Pump, Via Same Access | Nevada Prior Authorization List, Pg 39 Original policy |
| 36582 | Replacement, Complete, of a Tunneled Centrally Inserted Central Venous Access Device, w Sq Port, Via Same Access | Nevada Prior Authorization List, Pg 39 Original policy |
| 36583 | Replacement, Complete, of a Tunneled Centrally Inserted Central Venous Access Device, w Sq Pump, Via Same Access | Nevada Prior Authorization List, Pg 39 Original policy |
| 36589 | Removal of Tunneled Central Venous Catheter, without Subcutaneous Port or Pump | Nevada Prior Authorization List, Pg 39 Original policy |
| 36590 | Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peripheral Insertion | Nevada Prior Authorization List, Pg 39 Original policy |
| 36821 | Arteriovenous Anastomosis, Open; Direct, Any Site (Sep Proc) | Nevada Prior Authorization List, Pg 39 Original policy |
| 36901 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 39 Original policy |
| 36902 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 39 Original policy |
| 36903 | Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 39 Original policy |
| 36905 | Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis,dialysis circuit, any method, including all imaging and radiological supervision and interpr | Nevada Prior Authorization List, Pg 39 Original policy |
| 36906 | Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis,dialysis circuit, any method, including all imaging and radiological supervision and interpr | Nevada Prior Authorization List, Pg 39 Original policy |
| 37220 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty | Nevada Prior Authorization List, Pg 39 Original policy |
| 37221 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same ves | Nevada Prior Authorization List, Pg 39 Original policy |