Anthem Blue Cross and Blue Shield Nevada prior authorization, page 35

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
Code	Description	Source
68135	Destruction, Lesion, Conjunctiva	Nevada Prior Authorization List, Pg 77 Original policy
68320	Conjunctivoplasty; W/Conjunctival Graft/Extensive Rearrangement	Nevada Prior Authorization List, Pg 77 Original policy
68440	Snip Incision, Lacrimal Punctum	Nevada Prior Authorization List, Pg 77 Original policy
68530	Removal, Fb/Dacryolith, Lacrimal Passages	Nevada Prior Authorization List, Pg 77 Original policy
68700	Plastic Repair, Canaliculi	Nevada Prior Authorization List, Pg 77 Original policy
68720	Dacryocystorhinostomy (Fistulization, Lacrimal Sac To Nasal Cavity)	Nevada Prior Authorization List, Pg 77 Original policy
68750	Conjunctivorhinostomy; W/Insertion, Tube/Stent	Nevada Prior Authorization List, Pg 77 Original policy
68761	Closure, Lacrimal Punctum; Plug, Each	Nevada Prior Authorization List, Pg 77 Original policy
68801	Dilation, Lacrimal Punctum, W/Wo Irrigation	Nevada Prior Authorization List, Pg 77 Original policy
68811	Probing, Nasolacrimal Duct, W/Wo Irrigation; Requiring General Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
68815	Probing, Nasolacrimal Duct, W/Wo Irrigation; W/Insertion, Tube/Stent	Nevada Prior Authorization List, Pg 77 Original policy
69000	Drainage Ext Ear, Abscess/Hematoma; Simple	Nevada Prior Authorization List, Pg 77 Original policy
69090	Ear Piercing	Nevada Prior Authorization List, Pg 77 Original policy
69100	Bx Ext Ear	Nevada Prior Authorization List, Pg 77 Original policy
69110	Excision Ext Ear; Partial, Simple Repair	Nevada Prior Authorization List, Pg 77 Original policy
69140	Excision Exostosis(Es), Ext Auditory Canal	Nevada Prior Authorization List, Pg 77 Original policy
69145	Excision Soft Tissue Lesion, Ext Auditory Canal	Nevada Prior Authorization List, Pg 77 Original policy
69205	Removal Fb, Ext Auditory Canal; W/General Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
69222	Debridement, Mastoidectomy Cavity, Complex	Nevada Prior Authorization List, Pg 77 Original policy
69300	Otoplasty, Protruding Ear, W/Wo Size Reduction	Nevada Prior Authorization List, Pg 77 Original policy
69310	Reconstruction, Ext Auditory Canal (Sep Proc)	Nevada Prior Authorization List, Pg 77 Original policy
69320	Reconstruction, Ext Auditory Canal, Congenital Atresia, Single Stage	Nevada Prior Authorization List, Pg 77 Original policy
69421	Myringotomy W/Aspiration &/Or Eustachian Tube Inflation Requiring General Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
69424	Ventilating Tube Removal Requiring General Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
69433	Tympanostomy (Requiring Insertion, Ventilating Tube), Local/Topical Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
69436	Tympanostomy (Requiring Insertion, Ventilating Tube), General Anesthesia	Nevada Prior Authorization List, Pg 77 Original policy
69440	Middle Ear Exploration Through Postauricular/Ear Canal Incision	Nevada Prior Authorization List, Pg 77 Original policy
69450	Tympanolysis, Transcanal	Nevada Prior Authorization List, Pg 77 Original policy
69502	Mastoidectomy; Complete	Nevada Prior Authorization List, Pg 77 Original policy
69505	Mastoidectomy; Modified Radical	Nevada Prior Authorization List, Pg 77 Original policy
69550	Excision Aural Glomus Tumor; Transcanal	Nevada Prior Authorization List, Pg 78 Original policy
69602	Revision Mastoidectomy; Resulting In Modified Radical Mastoidectomy	Nevada Prior Authorization List, Pg 78 Original policy
69610	Tympanic Membrane Repair, W/Wo Site Preparation/Perforation, W/Wo Patch	Nevada Prior Authorization List, Pg 78 Original policy
69620	Myringoplasty (Surgery Confined To Drumhead & Donor Area)	Nevada Prior Authorization List, Pg 78 Original policy
69631	Tympanoplasty W/O Mastoidectomy Initial/Revision; W/O Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69632	Tympanoplasty W/O Mastoidectomy Initial/Revision; W/Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69633	Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision	Nevada Prior Authorization List, Pg 78 Original policy
69635	Tympanoplasty W/Antrotomy/Mastoidotomy; W/O Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69636	Tympanoplasty W/Antrotomy/Mastoidotomy; W/Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69641	Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69642	Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction	Nevada Prior Authorization List, Pg 78 Original policy
69643	Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction, Intact Wall	Nevada Prior Authorization List, Pg 78 Original policy
69644	Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction, Intact Wall	Nevada Prior Authorization List, Pg 78 Original policy
69645	Tympanoplasty W/Mastoidectomy; W/O Ossicle Reconstruction, Radical	Nevada Prior Authorization List, Pg 78 Original policy
69646	Tympanoplasty W/Mastoidectomy; W/Ossicle Reconstruction, Radical	Nevada Prior Authorization List, Pg 78 Original policy
69650	Stapes Mobilization	Nevada Prior Authorization List, Pg 78 Original policy
69660	Stabedectomy/Stapedotomy, W/Wo Foreign Matl	Nevada Prior Authorization List, Pg 78 Original policy
69661	Stabedectomy/Stapedotomy W/Wo Foreign Matl; W/Footplate Drill Out	Nevada Prior Authorization List, Pg 78 Original policy
69662	Revision, Stapedectomy/Stapedotomy	Nevada Prior Authorization List, Pg 78 Original policy
69666	Repair Oval Window Fistula	Nevada Prior Authorization List, Pg 78 Original policy

Sources

Nevada Prior Authorization List