Anthem Blue Cross and Blue Shield Nevada prior authorization, page 26
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 |
|---|---|---|
| 55500 | Excision, Hydrocele, Spermatic Cord, Unilat (Sep Proc) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55520 | Excision, Lesion, Spermatic Cord (Sep Proc) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55540 | Excision, Varicocele/Ligation, Spermatic Veins, Varicocele; W/Hernia Repair | Nevada Prior Authorization List, Pg 57 Original policy |
| 55707 | Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant, ultrasound- localized discrete lesion[s]) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55708 | Biopsy, prostate, transrectal, ultrasound-guided (ie,sextant) with MRI-fusion- guidance, first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55709 | Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound- localized discrete lesion[s]) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55710 | Biopsy, prostate, transperineal, ultrasound-guided (ie,sextant) with MRI-fusion- guidance biopsy, first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55711 | Biopsy, prostate, transrectal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55712 | Biopsy, prostate, transperineal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55713 | Biopsy, prostate, in-bore CT- or MRI-guided (ie, sextant), with biopsy of additional targeted lesion(s), first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55714 | Biopsy, prostate, in-bore CT- or MRI-guided targeted lesion(s) only, first targeted lesion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55860 | Exposure, Prostate, Any Approach, Radiation Insertion | Nevada Prior Authorization List, Pg 57 Original policy |
| 55862 | Exposure, Prostate, Any Approach, Radiation Insertion; W/Lymph Node Bx (Limited Pelvic Lymphadenect) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55865 | Exposure, Prostate, Any Approach, Radiation Insertion; W/Bilat Pelvic Lymphadenectomy | Nevada Prior Authorization List, Pg 57 Original policy |
| 55873 | Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring) | Nevada Prior Authorization List, Pg 57 Original policy |
| 55874 | Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed | Nevada Prior Authorization List, Pg 57 Original policy |
| 55875 | Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without | Nevada Prior Authorization List, Pg 57 Original policy |
| 55880 | Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance | Nevada Prior Authorization List, Pg 57 Original policy |
| 55881 | Transurethral ablation of prostate tissue, using thermal ultrasound | Nevada Prior Authorization List, Pg 57 Original policy |
| 55882 | Transurethral ablation of prostate tissue, using thermal ultrasound; with insertion of ultrasound transducer | Nevada Prior Authorization List, Pg 57 Original policy |
| 55920 | Placement of needles or catheters into pelvic organs and/or genitalia (expect prostate) for subsequent interstitial radi | Nevada Prior Authorization List, Pg 57 Original policy |
| 55970 | Intersex Surgery; Male To Female | Nevada Prior Authorization List, Pg 57 Original policy |
| 55980 | Intersex Surgery; Female To Male | Nevada Prior Authorization List, Pg 57 Original policy |
| 56405 | Incision & Drainage, Vulva/Perineal Abscess | Nevada Prior Authorization List, Pg 57 Original policy |
| 56420 | Incision & Drainage, Bartholin's Gland Abscess | Nevada Prior Authorization List, Pg 57 Original policy |
| 56440 | Marsupialization, Bartholin's Gland Cyst | Nevada Prior Authorization List, Pg 58 Original policy |
| 56441 | Lysis, Labial Adhesions | Nevada Prior Authorization List, Pg 58 Original policy |
| 56442 | Hymenotomy, simple incision | Nevada Prior Authorization List, Pg 58 Original policy |
| 56501 | Destruction, Lesion(S), Vulva; Simple | Nevada Prior Authorization List, Pg 58 Original policy |
| 56515 | Destruction, Lesion(S), Vulva; Extensive | Nevada Prior Authorization List, Pg 58 Original policy |
| 56605 | Bx, Vulva/Perineum (Sep Proc); 1 Lesion | Nevada Prior Authorization List, Pg 58 Original policy |
| 56620 | Vulvectomy Simple; Partial | Nevada Prior Authorization List, Pg 58 Original policy |
| 56625 | Vulvectomy Simple; Complete | Nevada Prior Authorization List, Pg 58 Original policy |
| 56700 | Partial Hymenectomy/Revision, Hymenal Ring | Nevada Prior Authorization List, Pg 58 Original policy |
| 56740 | Excision, Bartholin's Gland/Cyst | Nevada Prior Authorization List, Pg 58 Original policy |
| 56800 | Plastic Repair, Introitus | Nevada Prior Authorization List, Pg 58 Original policy |
| 56805 | Clitoroplasty, Intersex State | Nevada Prior Authorization List, Pg 58 Original policy |
| 56810 | Perineoplasty, Repair, Perineum, Nonobstetrical (Sep Proc) | Nevada Prior Authorization List, Pg 58 Original policy |
| 56821 | Colposcopy, Vulva; W/Biopsy(S) | Nevada Prior Authorization List, Pg 58 Original policy |
| 57000 | Colpotomy; W/Exploration | Nevada Prior Authorization List, Pg 58 Original policy |
| 57061 | Destruction, Vaginal Lesion(S); Simple | Nevada Prior Authorization List, Pg 58 Original policy |
| 57065 | Destruction, Vaginal Lesion(S); Extensive | Nevada Prior Authorization List, Pg 58 Original policy |
| 57100 | Bx, Vaginal Mucosa; Simple (Sep Proc) | Nevada Prior Authorization List, Pg 58 Original policy |
| 57105 | Bx, Vaginal Mucosa; Extensive, Requiring Suture (W/Cysts) | Nevada Prior Authorization List, Pg 58 Original policy |
| 57106 | Vaginectomy, Partial Removal, Vaginal Wall | Nevada Prior Authorization List, Pg 58 Original policy |
| 57110 | Vaginectomy, Complete Removal, Vaginal Wall | Nevada Prior Authorization List, Pg 58 Original policy |
| 57130 | Excision, Vaginal Septum | Nevada Prior Authorization List, Pg 58 Original policy |
| 57135 | Excision, Vaginal Cyst/Tumor | Nevada Prior Authorization List, Pg 58 Original policy |
| 57155 | Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy | Nevada Prior Authorization List, Pg 58 Original policy |
| 57156 | Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy | Nevada Prior Authorization List, Pg 58 Original policy |