Anthem Blue Cross and Blue Shield Nevada prior authorization, page 57
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 |
|---|---|---|
| 0506U | Gastroenterology (Barrett's esophagus), esophageal cells, DNA methylation analysis by next-generation sequencing of at least 89 differentially methylated genomic regions, algo | Nevada Prior Authorization List, Pg 125 Original policy |
| 0507U | Oncology (ovarian), DNA, whole-genome sequencing with 5- hydroxymethylcytosine (5hmC) enrichment, using whole blood or plasma, algorithm reported as cancer detected or not dete | Nevada Prior Authorization List, Pg 125 Original policy |
| 0510T | Removal of sinus tarsi implant | Nevada Prior Authorization List, Pg 125 Original policy |
| 0511T | Removal and reinsertion of sinus tarsi implant | Nevada Prior Authorization List, Pg 125 Original policy |
| 0511U | Oncology (solid tumor), tumor cell culture in 3D microenvironment, 36 or more drug panel, reported as tumor-response prediction for each drug | Nevada Prior Authorization List, Pg 125 Original policy |
| 0512T | Extracorporeal shock wave for integumentary wound healing, including topical application and dressing care; initial wound | Nevada Prior Authorization List, Pg 125 Original policy |
| 0515T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performe | Nevada Prior Authorization List, Pg 125 Original policy |
| 0516T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performe | Nevada Prior Authorization List, Pg 125 Original policy |
| 0516U | Drug metabolism, whole blood, pharmacogenomic genotyping of 40 genes and CYP2D6 copy number variant analysis, reported as metabolizer status | Nevada Prior Authorization List, Pg 125 Original policy |
| 0517T | Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging supervision and interpretation, when performe | Nevada Prior Authorization List, Pg 125 Original policy |
| 0518T | Removal of pulse generator for wireless cardiac stimulator for left ventricular pacing; battery component only | Nevada Prior Authorization List, Pg 126 Original policy |
| 0519T | Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; both components (batter | Nevada Prior Authorization List, Pg 126 Original policy |
| 0520T | Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming; battery component only | Nevada Prior Authorization List, Pg 126 Original policy |
| 0521T | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording, and disconnection per patient encounter, wireless cardiac stimula | Nevada Prior Authorization List, Pg 126 Original policy |
| 0521U | Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood | Nevada Prior Authorization List, Pg 126 Original policy |
| 0522T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values | Nevada Prior Authorization List, Pg 126 Original policy |
| 0523U | Oncology (solid tumor), DNA, qualitative, next-generation sequencing (NGS) of singlenucleotide variants (SNV) and insertion/deletions in 22 genes utilizing formalin-fixed par | Nevada Prior Authorization List, Pg 126 Original policy |
| 0524T | Endovenous catheter directed chemical ablation with balloon isolation of incompetent extremity vein, open or percutaneous, including all vascular access, catheter manipulation | Nevada Prior Authorization List, Pg 126 Original policy |
| 0524U | Obstetrics (preeclampsia), sFlt1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value | Nevada Prior Authorization List, Pg 126 Original policy |
| 0525T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpr | Nevada Prior Authorization List, Pg 126 Original policy |
| 0525U | Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib) | Nevada Prior Authorization List, Pg 126 Original policy |
| 0526T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpr | Nevada Prior Authorization List, Pg 126 Original policy |
| 0527T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpr | Nevada Prior Authorization List, Pg 126 Original policy |
| 0528T | Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report | Nevada Prior Authorization List, Pg 126 Original policy |
| 0529T | Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report | Nevada Prior Authorization List, Pg 126 Original policy |
| 0529U | Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis | Nevada Prior Authorization List, Pg 126 Original policy |
| 0530T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; complete system (electrode and implantable monitor) | Nevada Prior Authorization List, Pg 126 Original policy |
| 0530U | Oncology (pan-solid tumor), ctDNA, utilizing plasma, nextgeneration sequencing (NGS) of 77 genes, 8 fusions, microsatellite instability, and tumor mutation burden, interpreta | Nevada Prior Authorization List, Pg 126 Original policy |
| 0531T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; electrode only | Nevada Prior Authorization List, Pg 126 Original policy |
| 0532T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only | Nevada Prior Authorization List, Pg 126 Original policy |
| 0532U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome and mitochondrial DNA sequencing for single-nucleotide variants, insertions/deletions, copy num | Nevada Prior Authorization List, Pg 126 Original policy |
| 0533U | Drug metabolism (adverse drug reactions and drug response), genotyping of 16 genes (ie, ABCG2, CYP2B6, CYP2C9, CYP2C19, CYP2C, CYP2D6, CYP3A5, CYP4F2, DPYD, G6PD, GGCX, NUDT15 | Nevada Prior Authorization List, Pg 126 Original policy |
| 0534U | Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score | Nevada Prior Authorization List, Pg 127 Original policy |
| 0535U | Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), by liquid chromatography with tandem mass spectrometry (LC- MS/MS), plasma or seru | Nevada Prior Authorization List, Pg 127 Original policy |
| 0536U | Red blood cell antigen (fetal RhD), PCR analysis of exon 4 of RHD gene and housekeeping control gene GAPDH from whole blood in pregnant individuals at 10+ weeks gestation know | Nevada Prior Authorization List, Pg 127 Original policy |
| 0537U | Oncology (colorectal cancer), analysis of cell-free DNA for epigenomic patterns, next-generation sequencing, >2500 differentially methylated regions (DMRs), plasma, algorithm | Nevada Prior Authorization List, Pg 127 Original policy |
| 0538U | Oncology (solid tumor), next-generation targeted sequencing analysis, formalin- fixed paraffin-embedded (FFPE) tumor tissue, DNA analysis of 600 genes, interrogation for single | Nevada Prior Authorization List, Pg 127 Original policy |
| 0539U | Oncology (solid tumor), cell-free circulating tumor DNA (ctDNA), 152 genes, next-generation sequencing, interrogation for single-nucleotide variants, insertions/deletions, gen | Nevada Prior Authorization List, Pg 127 Original policy |
| 0540U | Transplantation medicine, quantification of donor-derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor-derived cell-free | Nevada Prior Authorization List, Pg 127 Original policy |
| 0543U | Oncology (solid tumor), next-generation sequencing of DNA from formalin-fixed paraffin-embedded (FFPE) tissue of 517 genes, interrogation for single- nucleotide variants, multi | Nevada Prior Authorization List, Pg 127 Original policy |
| 0544T | Transcatheter mitral valve annulus reconstruction, with implantation of adjustable annulus reconstruction device, percutaneous approach including transseptal puncture | Nevada Prior Authorization List, Pg 127 Original policy |
| 0545T | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device, percutaneous approach | Nevada Prior Authorization List, Pg 127 Original policy |
| 0546T | Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report | Nevada Prior Authorization List, Pg 127 Original policy |
| 0547U | Neurofilament light chain (NfL), chemiluminescent enzyme immunoassay, plasma, quantitative | Nevada Prior Authorization List, Pg 127 Original policy |
| 0549U | Oncology (urothelial), DNA, quantitative methylated real-time PCR of TRNA-Cys, SIM2, and NKX1-1, using urine, diagnostic algorithm reported as a probability index for bladder | Nevada Prior Authorization List, Pg 127 Original policy |
| 0552T | Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional | Nevada Prior Authorization List, Pg 127 Original policy |
| 0552U | Reproductive medicine (preimplantation genetic assessment), analysis for known genetic disorders from trophectoderm biopsy, linkage analysis of disease- causing locus, and when | Nevada Prior Authorization List, Pg 127 Original policy |
| 0553U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrang | Nevada Prior Authorization List, Pg 127 Original policy |
| 0554U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a | Nevada Prior Authorization List, Pg 127 Original policy |
| 0555U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrang | Nevada Prior Authorization List, Pg 127 Original policy |