Anthem Blue Cross and Blue Shield Nevada prior authorization, page 34
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 |
|---|---|---|
| 67141 | Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy | Nevada Prior Authorization List, Pg 75 Original policy |
| 67145 | Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation | Nevada Prior Authorization List, Pg 75 Original policy |
| 67210 | Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; photocoagulation | Nevada Prior Authorization List, Pg 75 Original policy |
| 67218 | Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of | Nevada Prior Authorization List, Pg 75 Original policy |
| 67221 | Destruction, Localized Lesion, Choroid; Photodynamic Therapy (W/Iv Infusion) | Nevada Prior Authorization List, Pg 75 Original policy |
| 67228 | Treatment of extensive or progressive retinopathy, 1 or more sessions; (eg, diabetic retinopathy), photocoagulation | Nevada Prior Authorization List, Pg 75 Original policy |
| 67311 | Strabismus surgery, recession or resection procedure; 1 horizontal muscle | Nevada Prior Authorization List, Pg 75 Original policy |
| 67312 | Strabismus surgery, recession or resection procedure; 2 horizontal muscles | Nevada Prior Authorization List, Pg 75 Original policy |
| 67314 | Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique) | Nevada Prior Authorization List, Pg 75 Original policy |
| 67316 | Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique) | Nevada Prior Authorization List, Pg 75 Original policy |
| 67318 | Strabismus Surgery, Any Proc, Superior Oblique Muscle | Nevada Prior Authorization List, Pg 75 Original policy |
| 67345 | Chemodenervation, Extraocular Muscle | Nevada Prior Authorization List, Pg 75 Original policy |
| 67400 | Orbitotomy W/O Bone Flap; Exploration, W/Wo Bx | Nevada Prior Authorization List, Pg 75 Original policy |
| 67412 | Orbitotomy W/O Bone Flap; W/Removal, Lesion | Nevada Prior Authorization List, Pg 75 Original policy |
| 67414 | Orbitotomy W/O Bone Flap; W/Removal, Bone, Decompression | Nevada Prior Authorization List, Pg 75 Original policy |
| 67420 | Orbitotomy W/Bone Flap/Window, Lateral Approach; W/Removal, Lesion | Nevada Prior Authorization List, Pg 75 Original policy |
| 67445 | Orbitotomy W/Bone Flap/Window, Lateral Approach; W/Removal, Bone, Decompression | Nevada Prior Authorization List, Pg 75 Original policy |
| 67550 | Orbital Implant (Outside Muscle Cone); Insertion | Nevada Prior Authorization List, Pg 75 Original policy |
| 67560 | Orbital Implant (Outside Muscle Cone); Removal/Revision | Nevada Prior Authorization List, Pg 75 Original policy |
| 67700 | Blepharotomy, Drainage, Abscess, Eyelid | Nevada Prior Authorization List, Pg 75 Original policy |
| 67800 | Excision, Chalazion; Single | Nevada Prior Authorization List, Pg 76 Original policy |
| 67801 | Excision, Chalazion; Multiple, Same Lid | Nevada Prior Authorization List, Pg 76 Original policy |
| 67805 | Excision, Chalazion; Multiple, Different Lids | Nevada Prior Authorization List, Pg 76 Original policy |
| 67808 | Excision, Chalazion; W/Anesthesia/Hospitalization, Single/Multiple | Nevada Prior Authorization List, Pg 76 Original policy |
| 67810 | Incisional biopsy of eyelid skin including lid margin | Nevada Prior Authorization List, Pg 76 Original policy |
| 67825 | Correction, Trichiasis; Epilation, Non-Forceps | Nevada Prior Authorization List, Pg 76 Original policy |
| 67840 | Excision, Lesion, Eyelid (Except Chalazion) W/O Closure Or W/Simple Direct Closure | Nevada Prior Authorization List, Pg 76 Original policy |
| 67875 | Temporary Closure, Eyelids, Suture | Nevada Prior Authorization List, Pg 76 Original policy |
| 67880 | Construction, Intermarginal Adhesions, Median Tarsorrhaphy/Canthorrhaphy | Nevada Prior Authorization List, Pg 76 Original policy |
| 67900 | Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach) | Nevada Prior Authorization List, Pg 76 Original policy |
| 67901 | Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) | Nevada Prior Authorization List, Pg 76 Original policy |
| 67902 | Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) | Nevada Prior Authorization List, Pg 76 Original policy |
| 67903 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Int Approach | Nevada Prior Authorization List, Pg 76 Original policy |
| 67904 | Repair, Blepharoptosis; (Tarso) Levator Resection/Advancement, Ext Approach | Nevada Prior Authorization List, Pg 76 Original policy |
| 67906 | Repair, Blepharoptosis; Superior Rectus W/Fascial Sling | Nevada Prior Authorization List, Pg 76 Original policy |
| 67908 | Repair, Blepharoptosis; Conjunctivo-Tarso-Muller's Muscle-Levator Resection | Nevada Prior Authorization List, Pg 76 Original policy |
| 67911 | Correction, Lid Retraction | Nevada Prior Authorization List, Pg 76 Original policy |
| 67917 | Repair, Ectropion; Extensive | Nevada Prior Authorization List, Pg 76 Original policy |
| 67924 | Repair, Entropion; Blepharoplasty, Extensive | Nevada Prior Authorization List, Pg 76 Original policy |
| 67935 | Suture, Recent Wound, Eyelid; Full Thickness | Nevada Prior Authorization List, Pg 76 Original policy |
| 67938 | Removal, Embedded Fb, Eyelid | Nevada Prior Authorization List, Pg 76 Original policy |
| 67950 | Canthoplasty (Reconstruction, Canthus) | Nevada Prior Authorization List, Pg 76 Original policy |
| 67961 | Excision/Repair, Eyelid; Up T0 One Quarter, Lid Margin | Nevada Prior Authorization List, Pg 76 Original policy |
| 67966 | Excision/Repair, Eyelid; > One Quarter, Lid Margin | Nevada Prior Authorization List, Pg 76 Original policy |
| 67971 | Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to 2/3 of eyelid | Nevada Prior Authorization List, Pg 76 Original policy |
| 67973 | Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower | Nevada Prior Authorization List, Pg 76 Original policy |
| 67975 | Reconstruction, Eyelid, Full Thickness; 2nd Stage | Nevada Prior Authorization List, Pg 76 Original policy |
| 68100 | Bx, Conjunctiva | Nevada Prior Authorization List, Pg 76 Original policy |
| 68110 | Excision, Lesion, Conjunctiva; Up To 1 Cm | Nevada Prior Authorization List, Pg 77 Original policy |
| 68115 | Excision, Lesion, Conjunctiva; > 1 Cm | Nevada Prior Authorization List, Pg 77 Original policy |