Anthem Blue Cross and Blue Shield Nevada prior authorization, page 30
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 |
|---|---|---|
| 63043 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or ex | Nevada Prior Authorization List, Pg 66 Original policy |
| 63044 | Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or ex | Nevada Prior Authorization List, Pg 66 Original policy |
| 63045 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Nevada Prior Authorization List, Pg 66 Original policy |
| 63046 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Nevada Prior Authorization List, Pg 66 Original policy |
| 63047 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Nevada Prior Authorization List, Pg 66 Original policy |
| 63048 | Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis | Nevada Prior Authorization List, Pg 66 Original policy |
| 63050 | Laminoplasty, Cervical, With Decompression Of The Spinal Cord, Two Or More Vertebral Segments | Nevada Prior Authorization List, Pg 66 Original policy |
| 63051 | Laminoplasty, Cerv, W Decompression Of Spinal Cord, 2 Or > Verteb Segments; W Reconstruction Of Posterior Bony Elements | Nevada Prior Authorization List, Pg 66 Original policy |
| 63052 | Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | Nevada Prior Authorization List, Pg 67 Original policy |
| 63053 | Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis] | Nevada Prior Authorization List, Pg 67 Original policy |
| 63055 | Transpedicular Approach, 1 Segment; Thoracic | Nevada Prior Authorization List, Pg 67 Original policy |
| 63056 | Transpedicular Approach, 1 Segment; Lumbar (Transfacet/Lateral Extraforaminal) | Nevada Prior Authorization List, Pg 67 Original policy |
| 63057 | Transpedicular Approach, Add'l Segment; Thoracic/Lumbar | Nevada Prior Authorization List, Pg 67 Original policy |
| 63075 | Diskectomy, Anterior; Cervical, 1 Interspace | Nevada Prior Authorization List, Pg 67 Original policy |
| 63076 | Diskectomy, Anterior; Cervical, Add'l Interspace | Nevada Prior Authorization List, Pg 67 Original policy |
| 63081 | Vertebral Corpectomy, Anterior; Cervical, 1 Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63082 | Vertebral Corpectomy, Anterior; Cervical, Add'l Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63085 | Vertebral Corpectomy, Transthoracic; Thoracic, 1 Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63086 | Vertebral Corpectomy, Transthoracic; Thoracic, Add'l Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63087 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; 1 Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63088 | Vertebral Corpectomy, Thoracolumbar, Lower Thoracic/Lumbar; Add'l Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63090 | Vertebral Corpectomy, Transperitoneal/Retroperitoneal, Lower Thoracic/Lumbar/Sacral; 1 Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63091 | Vertebral Corpectomy, Trans/Retroperitoneal, Lower Thoracic/Lumbar/Sacral; Add'l Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63101 | Vertebral Corpectomy, Lateral Extracavitary Approach w Decompression of Spinal Cord/Nerve Roots; Thoracic, Sgl Segment | Nevada Prior Authorization List, Pg 67 Original policy |
| 63102 | Vertebral Corpectomy, Lateral Extracavitary Approach w Decompression of Spinal Cord/Nerve Roots; Lumbar, Sgl Segment | Nevada Prior Authorization List, Pg 68 Original policy |
| 63103 | Vertebral Corpectomy, Lateral Extracavitary Approach w Decompression Spinal Cord/Nerve Rts; Thoracic/Lumbar, ea addl Seg | Nevada Prior Authorization List, Pg 68 Original policy |
| 63180 | Laminectomy and section of dentate ligaments, with or without dural graft, cervical; 1 or 2 segments | Nevada Prior Authorization List, Pg 68 Original policy |
| 63182 | Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than 2 segments | Nevada Prior Authorization List, Pg 68 Original policy |
| 63185 | Laminectomy with rhizotomy; 1 or 2 segments | Nevada Prior Authorization List, Pg 68 Original policy |
| 63190 | Laminectomy with rhizotomy; more than 2 segments | Nevada Prior Authorization List, Pg 68 Original policy |
| 63191 | Laminectomy W/Section, Spinal Accessory Nerve | Nevada Prior Authorization List, Pg 68 Original policy |
| 63194 | Laminectomy with cordotomy, with section of 1 spinothalamic tract, 1 stage; cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63196 | Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage; cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63198 | Laminectomy with cordotomy with section of both spinothalamic tracts, 2 stages within 14 days; cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63200 | Laminectomy, W/Release, Tethered Spinal Cord, Lumbar | Nevada Prior Authorization List, Pg 68 Original policy |
| 63250 | Laminectomy, Excision/Occlusion, Avm, Spinal Cord; Cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63252 | Laminectomy, Excision/Occlusion, Avm, Spinal Cord; Thoracolumbar | Nevada Prior Authorization List, Pg 68 Original policy |
| 63265 | Laminectomy, Excision, Non-Neoplastic Lesion, Extradural; Cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63267 | Laminectomy, Excision, Non-Neoplastic Lesion, Extradural; Lumbar | Nevada Prior Authorization List, Pg 68 Original policy |
| 63270 | Laminectomy, Excision, Intraspinal Lesion Other Than Neoplasm, Intradural; Cervical | Nevada Prior Authorization List, Pg 68 Original policy |
| 63272 | Laminectomy, Excision, Intraspinal Lesion Other Than Neoplasm, Intradural; Lumbar | Nevada Prior Authorization List, Pg 68 Original policy |
| 63275 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural, Cervical | Nevada Prior Authorization List, Pg 69 Original policy |
| 63277 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural, Lumbar | Nevada Prior Authorization List, Pg 69 Original policy |
| 63280 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Extramedullary, Cervical | Nevada Prior Authorization List, Pg 69 Original policy |
| 63282 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Extramedullary, Lumbar | Nevada Prior Authorization List, Pg 69 Original policy |
| 63285 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Intramedullary, Cervical | Nevada Prior Authorization List, Pg 69 Original policy |
| 63287 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Intradural, Intramedullary, Thoracolumbar | Nevada Prior Authorization List, Pg 69 Original policy |
| 63290 | Laminectomy, Bx/Excision, Intraspinal Neoplasm; Extradural-Intradural Lesion, Any Level | Nevada Prior Authorization List, Pg 69 Original policy |
| 63300 | Vertebral Corpectomy, 1 Segment; Extradural, Cervical | Nevada Prior Authorization List, Pg 69 Original policy |
| 63301 | Vertebral Corpectomy, 1 Segment; Extradural, Thoracic, Transthoracic Approach | Nevada Prior Authorization List, Pg 69 Original policy |