Anthem Blue Cross and Blue Shield Nevada prior authorization, page 21
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 |
|---|---|---|
| 45398 | Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45505 | Proctoplasty; Prolapse, Mucous Membrane | Nevada Prior Authorization List, Pg 47 Original policy |
| 45541 | Proctopexy (eg, for prolapse); perineal approach | Nevada Prior Authorization List, Pg 47 Original policy |
| 45560 | Repair, Rectocele (Sep Proc) | Nevada Prior Authorization List, Pg 47 Original policy |
| 45905 | Dilation, Anal Sphincter (Sep Proc) Under Anesthesia Other Than Local | Nevada Prior Authorization List, Pg 47 Original policy |
| 45910 | Dilation, Rectal Stricture (Sep Proc) Under Anesthesia Other Than Local | Nevada Prior Authorization List, Pg 47 Original policy |
| 45915 | Removal, Fecal Impaction/Fb (Sep Proc) Under Anesthesia | Nevada Prior Authorization List, Pg 47 Original policy |
| 45990 | Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic | Nevada Prior Authorization List, Pg 47 Original policy |
| 46020 | Placement, Seton | Nevada Prior Authorization List, Pg 47 Original policy |
| 46030 | Removal, Anal Seton, Other Marker | Nevada Prior Authorization List, Pg 48 Original policy |
| 46040 | Incision & Drainage, Ischiorectal &/Or Perirectal Abscess (Sep Proc) | Nevada Prior Authorization List, Pg 48 Original policy |
| 46045 | Incision & Drainage, Intramural/Intramuscular/Submucosal Abscess, Transanal, W/Anesthesia | Nevada Prior Authorization List, Pg 48 Original policy |
| 46050 | Incision & Drainage, Perianal Abscess, Superficial | Nevada Prior Authorization List, Pg 48 Original policy |
| 46060 | Incision & Drainage, Ischiorectal/Intramural Abscess, W/Fistulectomy/Otomy,Submuscular W/Wo Seton | Nevada Prior Authorization List, Pg 48 Original policy |
| 46080 | Sphincterotomy, Anal, Division, Sphincter (Sep Proc) | Nevada Prior Authorization List, Pg 48 Original policy |
| 46083 | Incision, Thrombosed Hemorrhoid, Ext | Nevada Prior Authorization List, Pg 48 Original policy |
| 46200 | Fissurectomy, including sphincterotomy, when performed | Nevada Prior Authorization List, Pg 48 Original policy |
| 46220 | Excision of single external papilla or tag, anus | Nevada Prior Authorization List, Pg 48 Original policy |
| 46221 | Hemorrhoidectomy, internal, by rubber band ligation(s) | Nevada Prior Authorization List, Pg 48 Original policy |
| 46230 | Excision of multiple external papillae or tags, anus | Nevada Prior Authorization List, Pg 48 Original policy |
| 46250 | Hemorrhoidectomy, external, 2 or more columns/groups | Nevada Prior Authorization List, Pg 48 Original policy |
| 46255 | Hemorrhoidectomy, internal and external, single column/group | Nevada Prior Authorization List, Pg 48 Original policy |
| 46257 | Hemorrhoidectomy, internal and external, single column/group; with fissurectomy | Nevada Prior Authorization List, Pg 48 Original policy |
| 46258 | Hemorrhoidectomy, internal and external, single column/group; with fistulectomy, including fissurectomy, when performed | Nevada Prior Authorization List, Pg 48 Original policy |
| 46260 | Hemorrhoidectomy, internal and external, 2 or more columns/groups | Nevada Prior Authorization List, Pg 48 Original policy |
| 46261 | Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy | Nevada Prior Authorization List, Pg 48 Original policy |
| 46262 | Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when perfo | Nevada Prior Authorization List, Pg 48 Original policy |
| 46270 | Surgical Treatment, Anal Fistula (Fistulectomy/Fistulotomy); Subq | Nevada Prior Authorization List, Pg 48 Original policy |
| 46275 | Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric | Nevada Prior Authorization List, Pg 48 Original policy |
| 46280 | Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or m | Nevada Prior Authorization List, Pg 48 Original policy |
| 46285 | Surgical Treatment, Anal Fistula (Fistulectomy/Fistulotomy); 2nd Stage | Nevada Prior Authorization List, Pg 48 Original policy |
| 46288 | Closure, Anal Fistula W/Rectal Advancement Flap | Nevada Prior Authorization List, Pg 48 Original policy |
| 46320 | Excision of thrombosed hemorrhoid, external | Nevada Prior Authorization List, Pg 48 Original policy |
| 46505 | Chemodenervation of internal anal sphincter | Nevada Prior Authorization List, Pg 48 Original policy |
| 46606 | Anoscopy; W/Bx, Single/Multiple | Nevada Prior Authorization List, Pg 48 Original policy |
| 46610 | Anoscopy; W/Removal, Single Lesion, Hot Forceps/Cautery | Nevada Prior Authorization List, Pg 48 Original policy |
| 46612 | Anoscopy; W/Removal, Multiple Lesions, Hot Forceps/Cautery/Snare | Nevada Prior Authorization List, Pg 48 Original policy |
| 46615 | Anoscopy; W/Ablation, Lesion, Not Removed By Hot Forceps/Cautery/Snare | Nevada Prior Authorization List, Pg 48 Original policy |
| 46700 | Anoplasty, Plastic Operation, Stricture; Adult | Nevada Prior Authorization List, Pg 48 Original policy |
| 46706 | Repair Of Anal Fistula W/Fibrin Glue | Nevada Prior Authorization List, Pg 48 Original policy |
| 46707 | Repair of anorectal fistula with plug (eg, porcine small intestine submucosa [SIS]) | Nevada Prior Authorization List, Pg 48 Original policy |
| 46750 | Sphincteroplasty, Anal, Incontinence/Prolapse; Adult | Nevada Prior Authorization List, Pg 48 Original policy |
| 46910 | Destruction, Anal Lesion(S), Simple; Electrodesiccation | Nevada Prior Authorization List, Pg 48 Original policy |
| 46917 | Destruction, Anal Lesion(S), Simple; Laser Surgery | Nevada Prior Authorization List, Pg 48 Original policy |
| 46922 | Destruction, Anal Lesion(S), Simple; Surgical Excision | Nevada Prior Authorization List, Pg 48 Original policy |
| 46924 | Destruction, Anal Lesion(S), Extensive | Nevada Prior Authorization List, Pg 48 Original policy |
| 46930 | Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency) | Nevada Prior Authorization List, Pg 48 Original policy |
| 46940 | Curettage/Cautery, Anal Fissure W/Dilation Sphincter (Sep Proc); Initial | Nevada Prior Authorization List, Pg 48 Original policy |
| 46945 | Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance | Nevada Prior Authorization List, Pg 48 Original policy |
| 46946 | Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance | Nevada Prior Authorization List, Pg 48 Original policy |