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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 33

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
66172Fistulization, Sclera, Glaucoma; Trabeculectomy Ab Externo W/Scarring, Previous Surg/TraumaNevada Prior Authorization List, Pg 73 Original policy
66174Transluminal dilation of aqueous outflow canal (eg, canaloplasty); without retention of device or stentNevada Prior Authorization List, Pg 73 Original policy
66175Transluminal dilation of aqueous outflow canal (eg, canaloplasty); with retention of device or stentNevada Prior Authorization List, Pg 73 Original policy
66179Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graftNevada Prior Authorization List, Pg 73 Original policy
66180Aqueous Shunt To Extraocular ReservoirNevada Prior Authorization List, Pg 73 Original policy
66183Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approachNevada Prior Authorization List, Pg 73 Original policy
66184Revision of aqueous shunt to extraocular equatorial plate reservoir; without graftNevada Prior Authorization List, Pg 73 Original policy
66185Revision, Aqueous Shunt To Extraocular ReservoirNevada Prior Authorization List, Pg 73 Original policy
66250Revision/Repair, Operative Wound, Anterior Segment, Any TypeNevada Prior Authorization List, Pg 73 Original policy
66682Suture, Iris, Ciliary Body (Sep Proc) W/Suture Retrieval W/Small IncisionNevada Prior Authorization List, Pg 73 Original policy
66683Iris prosthesis ImplantationNevada Prior Authorization List, Pg 74 Original policy
66710Ciliary Body Destruction; CyclophotocoagulationNevada Prior Authorization List, Pg 74 Original policy
66711Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lensNevada Prior Authorization List, Pg 74 Original policy
66761Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)Nevada Prior Authorization List, Pg 74 Original policy
66762Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of anterior chamber anNevada Prior Authorization List, Pg 74 Original policy
66821Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eNevada Prior Authorization List, Pg 74 Original policy
66825Repositioning, Intraocular Lens Prosthesis, Requiring An Incision (Sep Proc)Nevada Prior Authorization List, Pg 74 Original policy
66840Removal of lens material; aspiration technique, 1 or more stagesNevada Prior Authorization List, Pg 74 Original policy
66850Removal, Lens Material; Phacofragmentation, W/AspirationNevada Prior Authorization List, Pg 74 Original policy
66852Removal, Lens Material; Pars Plana Approach, W/Wo VitrectomyNevada Prior Authorization List, Pg 74 Original policy
66982Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
66983Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure)Nevada Prior Authorization List, Pg 74 Original policy
66984Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
66985Insertion, Intraocular Lens Prosthesis (Secondary Implant) (No Concurrent Cataract Removal)Nevada Prior Authorization List, Pg 74 Original policy
66986Exchange, Intraocular LensNevada Prior Authorization List, Pg 74 Original policy
66987Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
66988Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
66989Extracapsular cataract removal with insertion of intraocular lens prosthesis (1- stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
66991Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsifNevada Prior Authorization List, Pg 74 Original policy
67005Removal, Vitreous, Anterior Approach; Partial RemovalNevada Prior Authorization List, Pg 74 Original policy
67010Removal, Vitreous, Anterior Approach; Subtotal Removal W/Mech VitrectomyNevada Prior Authorization List, Pg 74 Original policy
67015Aspiration/Release, Vitreous/Subretinal/Choroidal Fluid, Pars Plana ApproachNevada Prior Authorization List, Pg 74 Original policy
67025Injection, Vitreous Substitute, Pars Plana/Limbal Approach, W/Wo Aspiration (Sep Proc)Nevada Prior Authorization List, Pg 74 Original policy
67027Implant, Intravitreal Drug Delivery System W/Removal, VitreousNevada Prior Authorization List, Pg 74 Original policy
67028Intravitreal Injection, A Pharmacologic Agent (Sep Proc)Nevada Prior Authorization List, Pg 74 Original policy
67031Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages)Nevada Prior Authorization List, Pg 74 Original policy
67036Vitrectomy, Mechanical, Pars Plana ApproachNevada Prior Authorization List, Pg 74 Original policy
67039Vitrectomy, Mechanical, Pars Plana Approach; W/Focal Endolaser PhotocoagulationNevada Prior Authorization List, Pg 74 Original policy
67040Vitrectomy, Mechanical, Pars Plana Approach; W/Endolaser Panretinal PhotocoagulationNevada Prior Authorization List, Pg 74 Original policy
67041Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g. macular pucker)Nevada Prior Authorization List, Pg 75 Original policy
67042Vitrectomy,mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg for repair of maculNevada Prior Authorization List, Pg 75 Original policy
67043Vitrectomy,mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), inclNevada Prior Authorization List, Pg 75 Original policy
67101Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapyNevada Prior Authorization List, Pg 75 Original policy
67105Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulationNevada Prior Authorization List, Pg 75 Original policy
67107Repair, Retinal Detachment; Scleral Buckling, W/Wo Implant/Cryo/Photocoag/Subretinal DrainageNevada Prior Authorization List, Pg 75 Original policy
67108Repair, Retinal Detachment; W/Vitrectomy, Any Method, W/Wo Tamponade/Laser/Cryo/Drain/Lens RemovalNevada Prior Authorization List, Pg 75 Original policy
67110Repair, Retinal Detachment; Injection, Air/Other GasNevada Prior Authorization List, Pg 75 Original policy
67113Repair of complex retinal detachment (eg. Proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinNevada Prior Authorization List, Pg 75 Original policy
67120Removal, Implanted Matl, Posterior Segment; ExtraocularNevada Prior Authorization List, Pg 75 Original policy
67121Removal, Implanted Matl, Posterior Segment; IntraocularNevada Prior Authorization List, Pg 75 Original policy

Sources

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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.

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