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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 32

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

Prior authorization codes
CodeDescriptionSource
64628Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacralNevada Prior Authorization List, Pg 72 Original policy
64629Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to codeNevada Prior Authorization List, Pg 72 Original policy
64633Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Cervical Or Thoracic, Single Facet JointNevada Prior Authorization List, Pg 72 Original policy
64634Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Cervical Or Thoracic, Each Additional Facet Joint (List SeparatNevada Prior Authorization List, Pg 72 Original policy
64635Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral, Single Facet JointNevada Prior Authorization List, Pg 72 Original policy
64636Destruction By Neurolytic Agent, Paravertebral Facet Joint Nerve(S), With Imaging Guidance (Fluoroscopy Or Ct); Lumbar Or Sacral, Each Additional Facet Joint (List SeparatelyNevada Prior Authorization List, Pg 72 Original policy
64640Destruction, Neurolytic; Other Peripheral Nerve/BranchNevada Prior Authorization List, Pg 72 Original policy
64716Neuroplasty &/Or Transposition; Cranial Nerve (Specify)Nevada Prior Authorization List, Pg 72 Original policy
64722Decompression; Unspecified Nerve(S) (Specify)Nevada Prior Authorization List, Pg 72 Original policy
64732Transection/Avulsion; Supraorbital NerveNevada Prior Authorization List, Pg 72 Original policy
64734Transection/Avulsion; Infraorbital NerveNevada Prior Authorization List, Pg 72 Original policy
64736Transection/Avulsion; Mental NerveNevada Prior Authorization List, Pg 72 Original policy
64738Transection/Avulsion; Inferior Alveolar Nerve, OsteotomyNevada Prior Authorization List, Pg 72 Original policy
64740Transection/Avulsion; Lingual NerveNevada Prior Authorization List, Pg 72 Original policy
64742Transection/Avulsion; Facial Nerve, Differential/CompleteNevada Prior Authorization List, Pg 72 Original policy
64744Transection/Avulsion; Greater Occipital NerveNevada Prior Authorization List, Pg 72 Original policy
64771Transection/Avulsion, Other Cranial Nerve, ExtraduralNevada Prior Authorization List, Pg 72 Original policy
64772Transection/Avulsion, Other Spinal Nerve, ExtraduralNevada Prior Authorization List, Pg 72 Original policy
64776Excision of neuroma; digital nerve, 1 or both, same digitNevada Prior Authorization List, Pg 72 Original policy
64782Excision, Neuroma; Hand/Foot, Except Digital NerveNevada Prior Authorization List, Pg 72 Original policy
64784Excision, Neuroma; Major Peripheral Nerve, Except SciaticNevada Prior Authorization List, Pg 72 Original policy
64788Excision, Neurofibroma/Neurolemmoma; Cutaneous NerveNevada Prior Authorization List, Pg 72 Original policy
64864Suture, Facial Nerve; ExtracranialNevada Prior Authorization List, Pg 72 Original policy
64865Suture, Facial Nerve; Infratemporal, W/Wo GraftingNevada Prior Authorization List, Pg 72 Original policy
64866Anastomosis; Facial-Spinal AccessoryNevada Prior Authorization List, Pg 72 Original policy
64868Anastomosis; Facial-HypoglossalNevada Prior Authorization List, Pg 72 Original policy
65275Repair, Laceration; Cornea, Nonperforating, W/Wo Removal FbNevada Prior Authorization List, Pg 72 Original policy
65400Excision, Lesion, Cornea (Keratectomy, Lamellar, Partial), Except PterygiumNevada Prior Authorization List, Pg 72 Original policy
65420Excision/Transposition, Pterygium; W/O GraftNevada Prior Authorization List, Pg 73 Original policy
65426Excision/Transposition, Pterygium; W/GraftNevada Prior Authorization List, Pg 73 Original policy
65435Removal, Corneal Epithelium; W/Wo Chemocauterization (Abrasion, Curettage)Nevada Prior Authorization List, Pg 73 Original policy
65436Removal, Corneal Epithelium; W/Application, Chelating AgentNevada Prior Authorization List, Pg 73 Original policy
65710Keratoplasty (corneal transplant); anterior lamellarNevada Prior Authorization List, Pg 73 Original policy
65730Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia)Nevada Prior Authorization List, Pg 73 Original policy
65750Keratoplasty (Corneal Transplant); Penetrating (In Aphakia)Nevada Prior Authorization List, Pg 73 Original policy
65755Keratoplasty (Corneal Transplant); Penetrating (In Pseudophakia)Nevada Prior Authorization List, Pg 73 Original policy
65756Keratoplasty (corneal transplant); endothelialNevada Prior Authorization List, Pg 73 Original policy
65778Placement of amniotic membrane on the ocular surface; without suturesNevada Prior Authorization List, Pg 73 Original policy
65779Placement of amniotic membrane on the ocular surface; single layer, suturedNevada Prior Authorization List, Pg 73 Original policy
65780Ocular surface reconstruction; amniotic membrane transplantation, multiple layersNevada Prior Authorization List, Pg 73 Original policy
65800Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueousNevada Prior Authorization List, Pg 73 Original policy
65815Paracentesis, Eye, Anterior Chamber (Sep Proc); W/Removal, Blood, W/Wo Irrigation/Air InjectionNevada Prior Authorization List, Pg 73 Original policy
65820GoniotomyNevada Prior Authorization List, Pg 73 Original policy
65850Trabeculotomy Ab ExternoNevada Prior Authorization List, Pg 73 Original policy
65855Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series)Nevada Prior Authorization List, Pg 73 Original policy
65865Severing Adhesions, Anterior Segment, Eye, Incisional (Sep Proc); GoniosynechiaeNevada Prior Authorization List, Pg 73 Original policy
65875Severing Adhesions, Anterior Segment, Eye, Incisional (Sep Proc); Posterior SynechiaeNevada Prior Authorization List, Pg 73 Original policy
65920Removal, Implanted Material, Anterior Segment, EyeNevada Prior Authorization List, Pg 73 Original policy
66020Injection, Anterior Chamber, Eye (Sep Proc); Air/LiquidNevada Prior Authorization List, Pg 73 Original policy
66170Fistulization, Sclera, Glaucoma; Trabeculectomy Ab Externo In Absence, Previous SurgeryNevada Prior Authorization List, Pg 73 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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