Anthem Blue Cross and Blue Shield Nevada prior authorization, page 63
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 |
|---|---|---|
| C1764 | Event recorder, cardiac (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1767 | Generator, neurostimulator (implantable), nonrechargeable | Nevada Prior Authorization List, Pg 137 Original policy |
| C1772 | Infusion pump, programmable (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1777 | Lead, cardioverter-defibrillator, endocardial single coil (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1778 | Lead, neurostimulator (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1785 | Pacemaker, dual chamber, rate-responsive (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1786 | Pacemaker, single chamber, rate-responsive (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1787 | Patient programmer, neurostimulator | Nevada Prior Authorization List, Pg 137 Original policy |
| C1789 | Prosthesis, breast (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1813 | Prosthesis, penile, inflatable | Nevada Prior Authorization List, Pg 137 Original policy |
| C1815 | Prosthesis, urinary sphincter (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1816 | Receiver and/or transmitter, neurostimulator (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1820 | Generator, neurostimulator (implantable), with rechargeable battery and charging system | Nevada Prior Authorization List, Pg 137 Original policy |
| C1821 | Interspinous process distraction device (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1822 | Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system | Nevada Prior Authorization List, Pg 137 Original policy |
| C1823 | Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads | Nevada Prior Authorization List, Pg 137 Original policy |
| C1824 | Generator, cardiac contractility modulation (implantable) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1825 | Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s) | Nevada Prior Authorization List, Pg 137 Original policy |
| C1832 | Autograft suspension, including cell processing and application, and all system components | Nevada Prior Authorization List, Pg 138 Original policy |
| C1833 | Monitor, cardiac, including intracardiac lead and all system components (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1839 | Iris prosthesis | Nevada Prior Authorization List, Pg 138 Original policy |
| C1878 | Material for vocal cord medialization, synthetic (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1882 | Cardioverter-defibrillator, other than single or dual chamber (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1883 | Adaptor/extension, pacing lead or neurostimulator lead (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1891 | Infusion pump, nonprogrammable, permanent (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1895 | Lead, cardioverter-defibrillator, endocardial dual coil (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C1896 | Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C2614 | Probe, percutaneous lumbar discectomy | Nevada Prior Authorization List, Pg 138 Original policy |
| C2619 | Pacemaker, dual chamber, nonrate-responsive (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C2620 | Pacemaker, single chamber, nonrate-responsive (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C2621 | Pacemaker, other than single or dual chamber (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C2622 | Prosthesis, penile, noninflatable | Nevada Prior Authorization List, Pg 138 Original policy |
| C2624 | Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components | Nevada Prior Authorization List, Pg 138 Original policy |
| C2626 | Infusion pump, nonprogrammable, temporary (implantable) | Nevada Prior Authorization List, Pg 138 Original policy |
| C5271 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area | Nevada Prior Authorization List, Pg 138 Original policy |
| C5272 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (lis | Nevada Prior Authorization List, Pg 138 Original policy |
| C5273 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of b | Nevada Prior Authorization List, Pg 138 Original policy |
| C5274 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area | Nevada Prior Authorization List, Pg 138 Original policy |
| C5275 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up t | Nevada Prior Authorization List, Pg 138 Original policy |
| C5276 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up t | Nevada Prior Authorization List, Pg 138 Original policy |
| C5277 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area grea | Nevada Prior Authorization List, Pg 138 Original policy |
| C5278 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area grea | Nevada Prior Authorization List, Pg 138 Original policy |
| C7513 | Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 138 Original policy |
| C7514 | Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 138 Original policy |
| C7515 | Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 139 Original policy |
| C7517 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with iliac and/or femoral artery angiograph | Nevada Prior Authorization List, Pg 139 Original policy |
| C7530 | Dialysis circuit, introduction of needle(s) and/or catheter(s), with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s) | Nevada Prior Authorization List, Pg 139 Original policy |
| C7531 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal angioplasty with intravascular ultrasound (initial noncoro | Nevada Prior Authorization List, Pg 139 Original policy |
| C7534 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with atherectomy, includes angioplasty within the same vessel, when performe | Nevada Prior Authorization List, Pg 139 Original policy |
| C7535 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(ies), unilateral, with transluminal stent placement(s), includes angioplasty within the same v | Nevada Prior Authorization List, Pg 139 Original policy |