Anthem Blue Cross and Blue Shield Nevada prior authorization, page 36
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 |
|---|---|---|
| 69705 | Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); unilateral | Nevada Prior Authorization List, Pg 78 Original policy |
| 69706 | Nasopharyngoscopy, surgical, with dilation of eustachian tube (ie, balloon dilation); bilateral | Nevada Prior Authorization List, Pg 78 Original policy |
| 69710 | Implantation/Replacement, Electromagnetic Bone Conduction Hearing Device, Temporal Bone | Nevada Prior Authorization List, Pg 78 Original policy |
| 69714 | Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor | Nevada Prior Authorization List, Pg 78 Original policy |
| 69715 | Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy | Nevada Prior Authorization List, Pg 78 Original policy |
| 69716 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than | Nevada Prior Authorization List, Pg 78 Original policy |
| 69717 | Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor | Nevada Prior Authorization List, Pg 78 Original policy |
| 69718 | Replacement, Osseointegrated Implant, Temporal Bone; W/Mastoidectomy | Nevada Prior Authorization List, Pg 78 Original policy |
| 69719 | Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid an | Nevada Prior Authorization List, Pg 78 Original policy |
| 69729 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater | Nevada Prior Authorization List, Pg 78 Original policy |
| 69730 | Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid a | Nevada Prior Authorization List, Pg 79 Original policy |
| 69801 | Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal | Nevada Prior Authorization List, Pg 79 Original policy |
| 69805 | Endolymphatic Sac Operation; W/O Shunt | Nevada Prior Authorization List, Pg 79 Original policy |
| 69806 | Endolymphatic Sac Operation; W/Shunt | Nevada Prior Authorization List, Pg 79 Original policy |
| 69930 | Cochlear Device Implantation, W/Wo Mastoidectomy | Nevada Prior Authorization List, Pg 79 Original policy |
| 69955 | Total Facial Nerve Decompression &/Or Repair, (May Include Graft) | Nevada Prior Authorization List, Pg 79 Original policy |
| 70336 | Mri, Temporomandibular Joints | Nevada Prior Authorization List, Pg 79 Original policy |
| 70450 | Ct Scan, Head/Brain; W/O Contrast Matl | Nevada Prior Authorization List, Pg 79 Original policy |
| 70460 | Ct Scan, Head/Brain; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 79 Original policy |
| 70470 | Ct Scan, Head/Brain; W/O Contrast, Then W/Contrast | Nevada Prior Authorization List, Pg 79 Original policy |
| 70480 | Ct Scan, Orbit/Sella/Posterior Fossa/Outer, Middle, Inner Ear; W/O Contrast | Nevada Prior Authorization List, Pg 79 Original policy |
| 70481 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/Contrast | Nevada Prior Authorization List, Pg 79 Original policy |
| 70482 | Ct Scan, Orbit/Sella/Posterior Fossa/ Outer, Middle, Inner Ear; W/O Contrast, Then W/Contrast | Nevada Prior Authorization List, Pg 79 Original policy |
| 70486 | Ct Scan, Maxillofacial Area; W/O Contrast Matl | Nevada Prior Authorization List, Pg 79 Original policy |
| 70487 | Ct Scan, Maxillofacial Area; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 79 Original policy |
| 70488 | Ct Scan, Maxillofacial Area; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 79 Original policy |
| 70490 | Ct Scan, Soft Tissue Neck; W/O Contrast Matl | Nevada Prior Authorization List, Pg 79 Original policy |
| 70491 | Ct Scan, Soft Tissue Neck; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 79 Original policy |
| 70492 | Ct Scan, Neck Tissue; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 79 Original policy |
| 70496 | Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing | Nevada Prior Authorization List, Pg 79 Original policy |
| 70498 | Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | Nevada Prior Authorization List, Pg 79 Original policy |
| 70540 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) | Nevada Prior Authorization List, Pg 79 Original policy |
| 70542 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) | Nevada Prior Authorization List, Pg 80 Original policy |
| 70543 | Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast ma | Nevada Prior Authorization List, Pg 80 Original policy |
| 70544 | Mra, Head; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 70545 | Mra, Head; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 70546 | Mra, Head; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Nevada Prior Authorization List, Pg 80 Original policy |
| 70547 | Mra, Neck; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 70548 | Mra, Neck; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 70549 | Mra, Neck; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Nevada Prior Authorization List, Pg 80 Original policy |
| 70551 | Mri, Brain; W/O Contrast | Nevada Prior Authorization List, Pg 80 Original policy |
| 70552 | Mri, Brain; W/Contrast | Nevada Prior Authorization List, Pg 80 Original policy |
| 70553 | Mri, Brain; W/O Contrast, Then W/Contrast & Further Sequences | Nevada Prior Authorization List, Pg 80 Original policy |
| 70554 | Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part m | Nevada Prior Authorization List, Pg 80 Original policy |
| 70555 | Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofun | Nevada Prior Authorization List, Pg 80 Original policy |
| 71250 | Computed tomography, thorax, diagnostic; without contrast material | Nevada Prior Authorization List, Pg 80 Original policy |
| 71260 | Computed tomography, thorax, diagnostic; with contrast material(s) | Nevada Prior Authorization List, Pg 80 Original policy |
| 71270 | Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections | Nevada Prior Authorization List, Pg 80 Original policy |
| 71271 | Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) | Nevada Prior Authorization List, Pg 80 Original policy |
| 71275 | Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if perfo | Nevada Prior Authorization List, Pg 80 Original policy |