Anthem Blue Cross and Blue Shield Nevada prior authorization, page 37
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 |
|---|---|---|
| 71550 | Mri, Chest; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 71551 | Mri, Chest; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 71552 | Mri, Chest; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Nevada Prior Authorization List, Pg 80 Original policy |
| 71555 | Mra, Chest (Exclude Myocardium), W/Wo Contrast Matl(S) | Nevada Prior Authorization List, Pg 80 Original policy |
| 72125 | Ct Scan, Cervical Spine; W/O Contrast | Nevada Prior Authorization List, Pg 80 Original policy |
| 72126 | Ct Scan, Cervical Spine; W/Contrast | Nevada Prior Authorization List, Pg 80 Original policy |
| 72127 | Ct Scan, Cervical Spine; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 81 Original policy |
| 72128 | Computed tomography, thoracic spine; without contrast material | Nevada Prior Authorization List, Pg 81 Original policy |
| 72129 | Cat,Thoracic Spine;w/Contrst Materl,18-2 | Nevada Prior Authorization List, Pg 81 Original policy |
| 72130 | Ct Scan, Thoracic Spine; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 81 Original policy |
| 72131 | Ct Scan, Lumbar Spine; W/O Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72132 | Ct Scan, Lumbar Spine; W/Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72133 | Ct Scan, Lumbar Spine; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 81 Original policy |
| 72141 | Mri, Cervical Spine; W/O Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72142 | Mri, Cervical Spine; W/Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72146 | Mri, Thoracic Spine; W/O Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72147 | Mri, Thoracic Spine; W/Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72148 | Mri, Lumbar Spine; W/O Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72149 | Mri, Lumbar Spine; W/Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72156 | Mri, Spine W/O Contrast, Then W/Contrast; Cervical | Nevada Prior Authorization List, Pg 81 Original policy |
| 72157 | Mri, Spine W/O Contrast, Then W/Contrast; Thoracic | Nevada Prior Authorization List, Pg 81 Original policy |
| 72158 | Mri, Spine W/O Contrast, Then W/Contrast; Lumbar | Nevada Prior Authorization List, Pg 81 Original policy |
| 72159 | Mra, Spine W/Wo Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72191 | Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and ima | Nevada Prior Authorization List, Pg 81 Original policy |
| 72192 | Ct Scan, Pelvis; W/O Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72193 | Ct Scan, Pelvis; W/Contrast | Nevada Prior Authorization List, Pg 81 Original policy |
| 72194 | Ct Scan, Pelvis; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 81 Original policy |
| 72195 | Mri, Pelvis; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 81 Original policy |
| 72196 | Mri, Pelvis; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 72197 | Mri, Pelvis; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequences | Nevada Prior Authorization List, Pg 82 Original policy |
| 72198 | Mra, Pelvis, W/Wo Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 72285 | Discography, cervical or thoracic, radiological supervision and interpretation | Nevada Prior Authorization List, Pg 82 Original policy |
| 72295 | Discography, lumbar, radiological supervision and interpretation | Nevada Prior Authorization List, Pg 82 Original policy |
| 73200 | Ct Scan, Upper Extremity; W/O Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 73201 | Ct Scan, Upper Extremity; W/Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 73202 | Ct Scan, Upper Extremity; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 82 Original policy |
| 73206 | Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed | Nevada Prior Authorization List, Pg 82 Original policy |
| 73218 | Mri, Upper Extremity, Other Than Joint; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 73219 | Mri, Upper Extremity, Other Than Joint; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 73220 | Mri, Upper Extremity, Other Than Joint; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Sequenc | Nevada Prior Authorization List, Pg 82 Original policy |
| 73221 | Mri, Any Joint, Upper Extremity; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 73222 | Mri, Any Joint, Upper Extremity; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 73223 | Mri, Any Joint Of Upper Extremity; W/O Contrast Matl(S), Followed By Contrast Matl(S) & Further Sequ | Nevada Prior Authorization List, Pg 82 Original policy |
| 73225 | Mra, Upper Extremity, W/Wo Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 73700 | Ct Scan, Lower Extremity; W/O Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 73701 | Ct Scan, Lower Extremity; W/Contrast | Nevada Prior Authorization List, Pg 82 Original policy |
| 73702 | Ct Scan, Lower Extremity; W/O Contrast, Then W/Contrast & Further Sections | Nevada Prior Authorization List, Pg 82 Original policy |
| 73706 | Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed | Nevada Prior Authorization List, Pg 82 Original policy |
| 73718 | Mri, Lower Extremity Other Than Joint; W/O Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |
| 73719 | Mri, Lower Extremity Other Than Joint; W/Contrast Matl(S) | Nevada Prior Authorization List, Pg 82 Original policy |