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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 66

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
D7947LeFort I (maxilla - segmented)Nevada Prior Authorization List, Pg 142 Original policy
D7948LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graftNevada Prior Authorization List, Pg 142 Original policy
D7949LeFort II or LeFort III - with bone graftNevada Prior Authorization List, Pg 142 Original policy
D7950osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by reportNevada Prior Authorization List, Pg 142 Original policy
D7995synthetic graft - mandible or facial bones, by reportNevada Prior Authorization List, Pg 142 Original policy
D7996implant-mandible for augmentation purposes (excluding alveolar ridge), by reportNevada Prior Authorization List, Pg 142 Original policy
D9222deep sedation/general anesthesia - first 15 minutesNevada Prior Authorization List, Pg 142 Original policy
D9223deep sedation/general anesthesia - each subsequent 15 minute incrementNevada Prior Authorization List, Pg 142 Original policy
D9950occlusion analysis - mounted caseNevada Prior Authorization List, Pg 142 Original policy
D9951occlusal adjustment - limitedNevada Prior Authorization List, Pg 142 Original policy
D9952occlusal adjustment - completeNevada Prior Authorization List, Pg 142 Original policy
E0217Water Circ Heat Pad W PumpNevada Prior Authorization List, Pg 142 Original policy
E0470Respiratory assist device, bi-level pressure capability, without backup rateNevada Prior Authorization List, Pg 142 Original policy
E0471Respiratory assist device, bi-level pressure capability, with back-up rateNevada Prior Authorization List, Pg 142 Original policy
E0481Intrapulmonary percussive ventilation system and related accessoriesNevada Prior Authorization List, Pg 142 Original policy
E0485Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includesNevada Prior Authorization List, Pg 142 Original policy
E0486Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, incluNevada Prior Authorization List, Pg 142 Original policy
E0490Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by hardware remoteNevada Prior Authorization List, Pg 142 Original policy
E0491Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by hardNevada Prior Authorization List, Pg 142 Original policy
E0492Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, controlled by phone applicationNevada Prior Authorization List, Pg 142 Original policy
E0493Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phonNevada Prior Authorization List, Pg 143 Original policy
E0530Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any typeNevada Prior Authorization List, Pg 143 Original policy
E0561Humidifier, non-heated, used with positive airway pressure deviceNevada Prior Authorization List, Pg 143 Original policy
E0562Humidifier, heated, used with positive airway pressure deviceNevada Prior Authorization List, Pg 143 Original policy
E0601Continuous positive airway pressure (cpap) deviceNevada Prior Authorization List, Pg 143 Original policy
E0616Cardiac Event RecorderNevada Prior Authorization List, Pg 143 Original policy
E0650Pneuma Compresor Non-SegmentNevada Prior Authorization List, Pg 143 Original policy
E0651Pneum Compressor SegmentalNevada Prior Authorization List, Pg 143 Original policy
E0652Pneum Compres W/Cal PressureNevada Prior Authorization List, Pg 143 Original policy
E0655Pneumatic Appliance Half ArmNevada Prior Authorization List, Pg 143 Original policy
E0656Segmental pneumatic appliance for use with pneumatic compressor, trunkNevada Prior Authorization List, Pg 143 Original policy
E0657Segmental pneumatic appliance for use with pneumatic compressor, chestNevada Prior Authorization List, Pg 143 Original policy
E0658Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chestNevada Prior Authorization List, Pg 143 Original policy
E0660Pneumatic Appliance Full LegNevada Prior Authorization List, Pg 143 Original policy
E0665Pneumatic Appliance Full ArmNevada Prior Authorization List, Pg 143 Original policy
E0666Pneumatic Appliance Half LegNevada Prior Authorization List, Pg 143 Original policy
E0667Seg Pneumatic Appl Full LegNevada Prior Authorization List, Pg 143 Original policy
E0668Seg Pneumatic Appl Full ArmNevada Prior Authorization List, Pg 143 Original policy
E0669Seg Pneumatic Appli Half LegNevada Prior Authorization List, Pg 143 Original policy
E0670Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunkNevada Prior Authorization List, Pg 143 Original policy
E0671Pressure Pneum Appl Full LegNevada Prior Authorization List, Pg 143 Original policy
E0672Pressure Pneum Appl Full ArmNevada Prior Authorization List, Pg 143 Original policy
E0673Pressure Pneum Appl Half LegNevada Prior Authorization List, Pg 143 Original policy
E0676INTERMITTENT LIMB COMPRESSION DEVICE (INCLUDES ALL ACCESSORIES), NOT OTHERWISENevada Prior Authorization List, Pg 143 Original policy
E0677Non-pneumatic sequential compression garment, trunkNevada Prior Authorization List, Pg 143 Original policy
E0678Non-pneumatic sequential compression garment, full legNevada Prior Authorization List, Pg 143 Original policy
E0679Non-pneumatic sequential compression garment, half legNevada Prior Authorization List, Pg 143 Original policy
E0680Non-pneumatic compression controller with sequential calibrated gradient pressureNevada Prior Authorization List, Pg 143 Original policy
E0681Non-pneumatic compression controller without calibrated gradient pressureNevada Prior Authorization List, Pg 143 Original policy
E0682Non-pneumatic sequential compression garment, full armNevada Prior Authorization List, Pg 143 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.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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