Anthem Blue Cross and Blue Shield Nevada prior authorization, page 20
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 |
|---|---|---|
| 44132 | Donor Enterectomy, Open, W/Prep & Maintenance, Allograft; Cadaver Donor | Nevada Prior Authorization List, Pg 46 Original policy |
| 44133 | Donor Enterectomy, Open With Prep & Maintenance, Allograft; Partial, Living Donor | Nevada Prior Authorization List, Pg 46 Original policy |
| 44135 | Intestinal Allotransplantation; From Cadaver Donor | Nevada Prior Authorization List, Pg 46 Original policy |
| 44136 | Intestinal Allotransplantation; From Living Donor | Nevada Prior Authorization List, Pg 46 Original policy |
| 44340 | Revision, Colostomy; Simple (Release, Superficial Scar) (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44360 | Small Intestinal Endo/Enteroscopy, > 2nd Portion Duodenum, Not W/Ileum; Dx W/Wo Specimen (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44361 | Small Intestinal Endo/Enteroscopy, > 2nd Portion Duodenum, Not W/Ileum; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 46 Original policy |
| 44364 | Small Intestinal Endo/Enteroscopy > 2nd Portion Duodenum, Not W/Ileum; W/Removal, Lesion, Snare | Nevada Prior Authorization List, Pg 46 Original policy |
| 44369 | Small Intestinal Endo/Enteroscopy > 2nd Portion Duodenum, Not W/Ileum; W/ Other Ablation, Lesion | Nevada Prior Authorization List, Pg 46 Original policy |
| 44376 | Small Intestinal Endo/Enteroscopy > 2nd Portion Duodenum, W/Ileum; Dx W/Wo Specimen (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44377 | Small Intestinal Endo/Enteroscopy > 2nd Portion Duodenum, W/Ileum; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 46 Original policy |
| 44380 | Ileoscopy, Through Stoma; Dx (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44381 | Ileoscopy, through stoma; with transendoscopic balloon dilation | Nevada Prior Authorization List, Pg 46 Original policy |
| 44382 | Ileoscopy, Through Stoma; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 46 Original policy |
| 44385 | Endoscopic Eval, Small Intestinal Pouch; Dx, W/Wo Specimen(S), Brushing/Washing (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44386 | Endoscopic Eval, Small Intestinal Pouch; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 46 Original policy |
| 44388 | Colonoscopy Through Stoma; Dx W/Wo Specimens, Brushing/Washing (Sep Proc) | Nevada Prior Authorization List, Pg 46 Original policy |
| 44389 | Colonoscopy Through Stoma; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 46 Original policy |
| 44392 | Colonoscopy Through Stoma; W/Removal, Lesion, Hot Forceps/Cautery | Nevada Prior Authorization List, Pg 46 Original policy |
| 44394 | Colonoscopy Through Stoma; W/Removal, Lesion, Snare | Nevada Prior Authorization List, Pg 46 Original policy |
| 44705 | Preparation of fecal microbiota for instillation, including assessment of donor specimen | Nevada Prior Authorization List, Pg 46 Original policy |
| 44715 | Backbench Standard Preparation Of Cadaver Or Living Donor Intestine Allograft | Nevada Prior Authorization List, Pg 46 Original policy |
| 44720 | Backbench Reconstruction Of Cadaver Or Living Donor Intestine Allograft; Venous Anastomosis, Each | Nevada Prior Authorization List, Pg 47 Original policy |
| 44721 | Backbench Reconstruction Of Cadaver Or Living Donor Intestine Allograft; Arterial Anastomosis, Each | Nevada Prior Authorization List, Pg 47 Original policy |
| 45100 | Bx, Anorectal Wall, Anal Approach | Nevada Prior Authorization List, Pg 47 Original policy |
| 45171 | Excision of rectal tumor, transanal approach; not including muscularis propria (ie, partial thickness) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45172 | Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45190 | Destruction, Rectal Tumor, Transanal Approach | Nevada Prior Authorization List, Pg 47 Original policy |
| 45305 | Proctosigmoidoscopy, Rigid; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 47 Original policy |
| 45330 | Sigmoidoscopy, Flexible; Dx, W/Wo Specimens, Brushing/Washing (Sep Proc) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45331 | Sigmoidoscopy, Flexible; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 47 Original policy |
| 45334 | Sigmoidoscopy, Flexible; W/Control, Bleeding | Nevada Prior Authorization List, Pg 47 Original policy |
| 45335 | Sigmoidoscopy, Flexible; W/Directed Submucosal Injection(S), Any Substance | Nevada Prior Authorization List, Pg 47 Original policy |
| 45340 | Sigmoidoscopy, Flexible; W/Dilation, Balloon, 1/> Strictures | Nevada Prior Authorization List, Pg 47 Original policy |
| 45341 | Sigmoidoscopy, Flexible; W/Endoscopic Ultrasound Exam | Nevada Prior Authorization List, Pg 47 Original policy |
| 45342 | Sigmoidoscopy, Flexible; W/Transendoscopic Ultrasound Guided Intra- /Transmural Fine Needle Aspir/Bx | Nevada Prior Authorization List, Pg 47 Original policy |
| 45346 | Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45349 | Sigmoidoscopy, flexible; with endoscopic mucosal resection | Nevada Prior Authorization List, Pg 47 Original policy |
| 45350 | Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45378 | Colonoscopy, Flexible, Proximal To Splenic Flexure; Dx, W/Wo Specimens/Colon Decomp (Sep Proc) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45379 | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Removal, Fb | Nevada Prior Authorization List, Pg 47 Original policy |
| 45380 | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 47 Original policy |
| 45381 | Colonoscpy, Flexible, Proximal To Splenic Flexure; W/Directed Submucosa Injection(S), Any Substance | Nevada Prior Authorization List, Pg 47 Original policy |
| 45384 | Colonoscopy, Flexible; W/Removal, Lesion, Hot Forceps/Cautery | Nevada Prior Authorization List, Pg 47 Original policy |
| 45385 | Colonoscopy, Flexible; W/Removal, Lesion, Snare | Nevada Prior Authorization List, Pg 47 Original policy |
| 45386 | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Dilation, Balloon, 1/> Strictures | Nevada Prior Authorization List, Pg 47 Original policy |
| 45388 | Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45389 | Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post- dilation and guide wire passage, when performed) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45390 | Colonoscopy, flexible; with endoscopic mucosal resection | Nevada Prior Authorization List, Pg 47 Original policy |
| 45391 | Colonoscopy, Flexible, Proximal To Splenic Flexure; With Endoscopic Ultrasound Examination | Nevada Prior Authorization List, Pg 47 Original policy |