Anthem Blue Cross and Blue Shield Nevada prior authorization, page 18
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 |
|---|---|---|
| 40810 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/O Repair | Nevada Prior Authorization List, Pg 42 Original policy |
| 40812 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/Simple Repair | Nevada Prior Authorization List, Pg 42 Original policy |
| 40814 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; W/Complex Repair | Nevada Prior Authorization List, Pg 42 Original policy |
| 40816 | Excision, Lesion, Mucosa & Submucosa, Vestibule, Mouth; Complex, W/Excision, Muscle | Nevada Prior Authorization List, Pg 42 Original policy |
| 41010 | Incision, Lingual Frenum (Frenotomy) | Nevada Prior Authorization List, Pg 42 Original policy |
| 41019 | Placement of needles, catheters, or other device(s) into the head and/or neck region (percutaneous, transoral, or transn | Nevada Prior Authorization List, Pg 42 Original policy |
| 41100 | Bx, Tongue; Anterior Two-Thirds | Nevada Prior Authorization List, Pg 42 Original policy |
| 41105 | Bx, Tongue; Posterior One-Third | Nevada Prior Authorization List, Pg 42 Original policy |
| 41108 | Bx, Mouth, Floor | Nevada Prior Authorization List, Pg 42 Original policy |
| 41110 | Excision, Lesion, Tongue W/O Closure | Nevada Prior Authorization List, Pg 42 Original policy |
| 41112 | Excision, Lesion, Tongue W/Closure; Anterior Two-Thirds | Nevada Prior Authorization List, Pg 42 Original policy |
| 41113 | Excision, Lesion, Tongue W/Closure; Posterior One-Third | Nevada Prior Authorization List, Pg 43 Original policy |
| 41116 | Excision, Lesion, Mouth Floor | Nevada Prior Authorization List, Pg 43 Original policy |
| 41512 | Tongue base suspension, permanent suture technique | Nevada Prior Authorization List, Pg 43 Original policy |
| 41520 | Frenoplasty | Nevada Prior Authorization List, Pg 43 Original policy |
| 41530 | Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session | Nevada Prior Authorization List, Pg 43 Original policy |
| 41825 | Excision, Lesion/Tumor (Except Listed Above), Dentoalveolar Structures; W/O Repair | Nevada Prior Authorization List, Pg 43 Original policy |
| 42100 | Bx, Palate, Uvula | Nevada Prior Authorization List, Pg 43 Original policy |
| 42104 | Excision, Lesion, Palate, Uvula; W/O Closure | Nevada Prior Authorization List, Pg 43 Original policy |
| 42106 | Excision, Lesion, Palate, Uvula; W/Simple Primary Closure | Nevada Prior Authorization List, Pg 43 Original policy |
| 42107 | Excision, Lesion, Palate, Uvula; W/Local Flap Closure | Nevada Prior Authorization List, Pg 43 Original policy |
| 42140 | Uvulectomy, Excision, Uvula | Nevada Prior Authorization List, Pg 43 Original policy |
| 42145 | Palatopharyngoplasty | Nevada Prior Authorization List, Pg 43 Original policy |
| 42330 | Sialolithotomy; Submandibular (Submaxillary), Sublingual/Parotid, Uncomplicated, Intraoral | Nevada Prior Authorization List, Pg 43 Original policy |
| 42335 | Sialolithotomy; Submandibular (Submaxillary), Complicated, Intraoral | Nevada Prior Authorization List, Pg 43 Original policy |
| 42405 | Bx, Salivary Gland; Incisional | Nevada Prior Authorization List, Pg 43 Original policy |
| 42408 | Excision, Sublingual Salivary Cyst (Ranula) | Nevada Prior Authorization List, Pg 43 Original policy |
| 42410 | Excision, Parotid Tumor/Parotid Gland; Lateral Lobe, W/O Nerve Dissection | Nevada Prior Authorization List, Pg 43 Original policy |
| 42415 | Excision, Parotid Tumor/Parotid Gland; Lateral Lobe, W/Nerve Dissection, Preservation, Facial Nerve | Nevada Prior Authorization List, Pg 43 Original policy |
| 42420 | Excision, Parotid Tumor/Parotid Gland; Total, W/Nerve Dissection, Preservation, Facial Nerve | Nevada Prior Authorization List, Pg 43 Original policy |
| 42425 | Excision, Parotid Tumor/Parotid Gland; Total, En Bloc, Nerve Removal | Nevada Prior Authorization List, Pg 43 Original policy |
| 42440 | Excision, Submandibular (Submaxillary) Gland | Nevada Prior Authorization List, Pg 43 Original policy |
| 42450 | Excision, Sublingual Gland | Nevada Prior Authorization List, Pg 43 Original policy |
| 42500 | Plastic Repair, Salivary Duct, Sialodochoplasty; Primary/Simple | Nevada Prior Authorization List, Pg 43 Original policy |
| 42650 | Dilation Salivary Duct | Nevada Prior Authorization List, Pg 43 Original policy |
| 42800 | Bx; Oropharynx | Nevada Prior Authorization List, Pg 43 Original policy |
| 42804 | Bx; Nasopharynx, Visible Lesion, Simple | Nevada Prior Authorization List, Pg 43 Original policy |
| 42808 | Excision/Destruction, Lesion, Pharynx, Any Method | Nevada Prior Authorization List, Pg 43 Original policy |
| 42810 | Excision, Branchial Cleft Cyst/Vestige, Confined To Skin & Subq Tissues | Nevada Prior Authorization List, Pg 43 Original policy |
| 42870 | Excision/Destruction Lingual Tonsil, Any Method (Sep Proc) | Nevada Prior Authorization List, Pg 43 Original policy |
| 43192 | Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance | Nevada Prior Authorization List, Pg 43 Original policy |
| 43195 | Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) | Nevada Prior Authorization List, Pg 43 Original policy |
| 43197 | Esophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) by brushing or washing when performed (separate procedure) | Nevada Prior Authorization List, Pg 43 Original policy |
| 43200 | Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Nevada Prior Authorization List, Pg 44 Original policy |
| 43201 | Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance | Nevada Prior Authorization List, Pg 44 Original policy |
| 43202 | Esophagoscopy, flexible, transoral; with biopsy, single or multiple | Nevada Prior Authorization List, Pg 44 Original policy |
| 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed | Nevada Prior Authorization List, Pg 44 Original policy |
| 43214 | Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) | Nevada Prior Authorization List, Pg 44 Original policy |
| 43220 | Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) | Nevada Prior Authorization List, Pg 44 Original policy |
| 43226 | Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire | Nevada Prior Authorization List, Pg 44 Original policy |