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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 64

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
C7538Insertion of new or replacement of permanent pacemaker with ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for left ventriculNevada Prior Authorization List, Pg 139 Original policy
C7539Insertion of new or replacement of permanent pacemaker with atrial and ventricular transvenous electrode(s), with insertion of pacing electrode, cardiac venous system, for lefNevada Prior Authorization List, Pg 139 Original policy
C7540Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator, dual lead system, with insertion of pacing electrode, cardiac venous system, forNevada Prior Authorization List, Pg 139 Original policy
C7552Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 139 Original policy
C7553Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; witNevada Prior Authorization List, Pg 139 Original policy
C8002Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (do not report with manual suspension preparation)Nevada Prior Authorization List, Pg 139 Original policy
C8003Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning andNevada Prior Authorization List, Pg 139 Original policy
C8903Magnetic resonance imaging with contrast, breast; unilateralNevada Prior Authorization List, Pg 139 Original policy
C8905Magnetic resonance imaging without contrast followed by with contrast, breast; unilateralNevada Prior Authorization List, Pg 139 Original policy
C8906Magnetic resonance imaging with contrast, breast; bilateralNevada Prior Authorization List, Pg 139 Original policy
C8908Magnetic resonance imaging without contrast followed by with contrast, breast; bilateralNevada Prior Authorization List, Pg 139 Original policy
C9047Injection, caplacizumab-yhdp, 1 mgNevada Prior Authorization List, Pg 139 Original policy
C9076Lisocabtagene maraleucel, up to 110 million autologous anti-CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic doseNevada Prior Authorization List, Pg 139 Original policy
C9077Injection, cabotegravir and rilpivirine, 2 mg/3 mgNevada Prior Authorization List, Pg 139 Original policy
C9079Injection, evinacumab-dgnb, 5 mgNevada Prior Authorization List, Pg 139 Original policy
C9081Idecabtagene vicleucel, up to 460 million autologous anti-BCMA CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic doseNevada Prior Authorization List, Pg 139 Original policy
C9085Injection, avalglucosidase alfa-ngpt, 4 mgNevada Prior Authorization List, Pg 139 Original policy
C9086Injection, anifrolumab-fnia, 1 mgNevada Prior Authorization List, Pg 139 Original policy
C9090Injection, plasminogen, human-tvmh, 1 mgNevada Prior Authorization List, Pg 139 Original policy
C9094Injection, sutimlimab-jome, 10 mgNevada Prior Authorization List, Pg 139 Original policy
C9096Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcgNevada Prior Authorization List, Pg 139 Original policy
C9097Injection, faricimab-svoa, 0.1 mgNevada Prior Authorization List, Pg 139 Original policy
C9098Ciltacabtagene autoleucel, up to 100 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation proceduresNevada Prior Authorization List, Pg 140 Original policy
C9149Injection, teplizumab-mzwv, 5 mcgNevada Prior Authorization List, Pg 140 Original policy
C9151Injection, pegcetacoplan, 1 mgNevada Prior Authorization List, Pg 140 Original policy
C9157Injection, tofersen, 1 mgNevada Prior Authorization List, Pg 140 Original policy
C9160Injection, daxibotulinumtoxina-lanm, 1 unitNevada Prior Authorization List, Pg 140 Original policy
C9161Injection, aflibercept hd, 1 mgNevada Prior Authorization List, Pg 140 Original policy
C9162Injection, avacincaptad pegol, 0.1 mgNevada Prior Authorization List, Pg 140 Original policy
C9166Injection, secukinumab, IV, 1 mgNevada Prior Authorization List, Pg 140 Original policy
C9167Injection, apadamtase alfa, 10 unitsNevada Prior Authorization List, Pg 140 Original policy
C9168Injection, mirikizumab-mrkz, 1 mgNevada Prior Authorization List, Pg 140 Original policy
C9173Injection, filgrastim-txid (Nypozi), biosimilar, 1 mcgNevada Prior Authorization List, Pg 140 Original policy
C9257Injection, bevacizumab, 0.25 mgNevada Prior Authorization List, Pg 140 Original policy
C9304Injection, marstacimab-hncq, 0.5 mgNevada Prior Authorization List, Pg 140 Original policy
C9305Injection, nipocalimab-aahu, 3 mgNevada Prior Authorization List, Pg 140 Original policy
C9352Microporous collagen implantable tube (NeuraGen Nerve Guide), per cm lengthNevada Prior Authorization List, Pg 140 Original policy
C9353Microporous collagen implantable slit tube (NeuraWrap Nerve Protector), per cm lengthNevada Prior Authorization List, Pg 140 Original policy
C9354Acellular pericardial tissue matrix of nonhuman origin (Veritas), per sq cmNevada Prior Authorization List, Pg 140 Original policy
C9355Collagen nerve cuff (NeuroMatrix), per 0.5 cm lengthNevada Prior Authorization List, Pg 140 Original policy
C9356Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix (TenoGlide Tendon Protector Sheet), per sq cmNevada Prior Authorization List, Pg 140 Original policy
C9358Dermal substitute, native, nondenatured collagen, fetal bovine origin (SurgiMend Collagen Matrix), per 0.5 sq cmNevada Prior Authorization List, Pg 140 Original policy
C9359Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 ccNevada Prior Authorization List, Pg 140 Original policy
C9360Dermal substitute, native, nondenatured collagen, neonatal bovine origin (SurgiMend Collagen Matrix), per 0.5 sq cmNevada Prior Authorization List, Pg 140 Original policy
C9361Collagen matrix nerve wrap (NeuroMend Collagen Nerve Wrap), per 0.5 cm lengthNevada Prior Authorization List, Pg 140 Original policy
C9362Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Strip), per 0.5 ccNevada Prior Authorization List, Pg 140 Original policy
C9363Skin substitute (Integra Meshed Bilayer Wound Matrix), per square cmNevada Prior Authorization List, Pg 140 Original policy
C9364Porcine implant, Permacol, per sq cmNevada Prior Authorization List, Pg 140 Original policy
C9600Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branchNevada Prior Authorization List, Pg 140 Original policy
C9601Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (listNevada Prior Authorization List, Pg 140 Original policy

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

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