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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 47

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
93152Interrogation and programming of implanted phrenic nerve stimulator system during polysomnographyNevada Prior Authorization List, Pg 102 Original policy
93153Interrogation without programming of implanted phrenic nerve stimulator systemNevada Prior Authorization List, Pg 102 Original policy
93228External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG dataNevada Prior Authorization List, Pg 102 Original policy
93229External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG dataNevada Prior Authorization List, Pg 102 Original policy
93264Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretationNevada Prior Authorization List, Pg 102 Original policy
93303Transthoracic Echocardiography, Congenital Cardiac Anomalies; CompleteNevada Prior Authorization List, Pg 102 Original policy
93304Transthoracic Echocardiography, Congenital Cardiac Anomalies; Follow- Up/Limited StudyNevada Prior Authorization List, Pg 102 Original policy
93306Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, comNevada Prior Authorization List, Pg 102 Original policy
93307Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, comNevada Prior Authorization List, Pg 102 Original policy
93308Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, folNevada Prior Authorization List, Pg 102 Original policy
93312Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); includingNevada Prior Authorization List, Pg 103 Original policy
93313Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placementNevada Prior Authorization List, Pg 103 Original policy
93314Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acqNevada Prior Authorization List, Pg 103 Original policy
93315Echocardiography, Transesophageal, Congenital Anomalies; W/Probe, Image, Intepretation & ReportNevada Prior Authorization List, Pg 103 Original policy
93316Echocardiography, Transesophageal, Congenital Anomalies; Transesophageal Probe Placement OnlyNevada Prior Authorization List, Pg 103 Original policy
93317Echocardiography, Transesophageal, Congenital Anomalies; Image, Interpretation & ReportNevada Prior Authorization List, Pg 103 Original policy
93350Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, durNevada Prior Authorization List, Pg 103 Original policy
93351Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmillNevada Prior Authorization List, Pg 103 Original policy
93454Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretationNevada Prior Authorization List, Pg 103 Original policy
93455Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93456Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93457Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93458Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93459Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93460Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93461Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 103 Original policy
93580Perc Transcatheter Closure, Congenital Interatrial Communication W/ImplantNevada Prior Authorization List, Pg 103 Original policy
93600Bundle Of His RecordingNevada Prior Authorization List, Pg 103 Original policy
93602Intra-Atrial RecordingNevada Prior Authorization List, Pg 103 Original policy
93603Right Ventricular RecordingNevada Prior Authorization List, Pg 103 Original policy
93609Intraventricular &/Or Intra-Atrial Mapping, Tachycardia Site(S) W/Catheter ManipulationNevada Prior Authorization List, Pg 103 Original policy
93613Intracardiac Electrophysiologic 3-Dimensional MappingNevada Prior Authorization List, Pg 104 Original policy
93619Electrophys Eval, W/Right Atrial/Ventricular Pace/Recording, Insertion Cath, W/O Arrhyth InductionNevada Prior Authorization List, Pg 104 Original policy
93620Electrophys Eval, Insert Cath, W/Arrhyth Induction; W/Right Atrial/Ventricular Pace/RecordNevada Prior Authorization List, Pg 104 Original policy
93621Electrophys Eval, Insert Cath, W/Arrhyth Induction; W/Lt Atrial Pace/RecordNevada Prior Authorization List, Pg 104 Original policy
93622Electrophys Eval, Insert Cath, W/Arrythmia Induction; W/Lt Vent Pace/RecordNevada Prior Authorization List, Pg 104 Original policy
93624Electrophys, Follow-Up Study W/Pacing & Recording W/Arrhyth InductionNevada Prior Authorization List, Pg 104 Original policy
93640Electrophys Eval, Single/Dual Pacing Cardio/Defib Leads, Initial Implant/ReplaceNevada Prior Authorization List, Pg 104 Original policy
93641Electrophys Eval, Single/Dual Pacing Cardio/Defib Leads, Initial Implant/Replace; W/Pulse GeneratorNevada Prior Authorization List, Pg 104 Original policy
93650Intracardiac Catheter Ablation, Atrioventricular Node Function/ConductionNevada Prior Authorization List, Pg 104 Original policy
93653Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atriNevada Prior Authorization List, Pg 104 Original policy
93654Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atriNevada Prior Authorization List, Pg 104 Original policy
93656Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction ofNevada Prior Authorization List, Pg 104 Original policy
93657Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolatiNevada Prior Authorization List, Pg 104 Original policy
93701Bioimpedance-derived physiologic cardiovascular analysisNevada Prior Authorization List, Pg 104 Original policy
93880Duplex Scan, Extracranial Arteries; Complete Bilat StudyNevada Prior Authorization List, Pg 104 Original policy
93882Duplex Scan, Extracranial Arteries; Unilat/Limited StudyNevada Prior Authorization List, Pg 104 Original policy
93922Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anteriorNevada Prior Authorization List, Pg 104 Original policy
93923Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posteriorNevada Prior Authorization List, Pg 104 Original policy
93924Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing (ie, bidirectional Doppler waveform or volume plethysmography recorNevada Prior Authorization List, Pg 104 Original policy

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