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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 69

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
J0221Injection, alglucosidase alfa, (Lumizyme), 10 mgNevada Prior Authorization List, Pg 146 Original policy
J0222Injection, Patisiran, 0.1 mgNevada Prior Authorization List, Pg 146 Original policy
J0223Injection, givosiran, 0.5 mgNevada Prior Authorization List, Pg 146 Original policy
J0224Injection, lumasiran, 0.5 mNevada Prior Authorization List, Pg 146 Original policy
J0225Injection, vutrisiran, 1 mgNevada Prior Authorization List, Pg 146 Original policy
J0256Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mgNevada Prior Authorization List, Pg 146 Original policy
J0257Injection, alpha 1 proteinase inhibitor (human), (GLASSIA), 10 mgNevada Prior Authorization List, Pg 146 Original policy
J0456AzithromycinNevada Prior Authorization List, Pg 146 Original policy
J0485Injection, belatacept, 1 mgNevada Prior Authorization List, Pg 146 Original policy
J0490Injection, belimumab, 10 mgNevada Prior Authorization List, Pg 147 Original policy
J0491Injection, anifrolumab-fnia, 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0517Injection, benralizumab, 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0558Injection, penicillin g benzathine and penicillin g procaine, 100,000 unitsNevada Prior Authorization List, Pg 147 Original policy
J0561Injection, penicillin g benzathine, 100,000 unitsNevada Prior Authorization List, Pg 147 Original policy
J0565Injection, bezlotoxumab, 10 mgNevada Prior Authorization List, Pg 147 Original policy
J0567Injection, cerliponase alfa, 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0584Injection, burosumab-twza 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0585Injection, Onabotulinumtoxina, 1 UnitNevada Prior Authorization List, Pg 147 Original policy
J0586Injection, Abobotulinumtoxina, 5 UnitsNevada Prior Authorization List, Pg 147 Original policy
J0587Injection, Rimabotulinumtoxinb, 100 UnitsNevada Prior Authorization List, Pg 147 Original policy
J0588Injection, incobotulinumtoxinA, 1 unitNevada Prior Authorization List, Pg 147 Original policy
J0589Injection, daxibotulinumtoxina-lanm, 1 unitNevada Prior Authorization List, Pg 147 Original policy
J0593Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered)Nevada Prior Authorization List, Pg 147 Original policy
J0596Injection, c1 esterase inhibitor (recombinant), ruconest, 10 unitsNevada Prior Authorization List, Pg 147 Original policy
J0597Injection, c-1 esterase inhibitor (human), berinert, 10 unitsNevada Prior Authorization List, Pg 147 Original policy
J0598Injection, c-1 esterase inhibitor (human), cinryze, 10 unitsNevada Prior Authorization List, Pg 147 Original policy
J0599Injection, C-1 esterase inhibitor (human), (Haegarda), 10 unitsNevada Prior Authorization List, Pg 147 Original policy
J0614Injection, treosulfan, 50 mgNevada Prior Authorization List, Pg 147 Original policy
J0638Injection, canakinumab, 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0641Injection, levoleucovorin, not otherwise specified, 0.5 mgNevada Prior Authorization List, Pg 147 Original policy
J0642Injection, levoleucovorin (khapzory), 0.5 mgNevada Prior Authorization List, Pg 147 Original policy
J0687Injection, cefazolin sodium (WG Critical Care), not therapeutically equivalent to J0690, 500 mgNevada Prior Authorization List, Pg 147 Original policy
J0688Injection, cefazolin sodium (hikma), not therapeutically equivalent to j0690, 500 mgNevada Prior Authorization List, Pg 147 Original policy
J0689Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mgNevada Prior Authorization List, Pg 147 Original policy
J0690Cefazolin Sodium InjectionNevada Prior Authorization List, Pg 147 Original policy
J0696Ceftriaxone Sodium InjectionNevada Prior Authorization List, Pg 147 Original policy
J0698Cefotaxime Sodium InjectionNevada Prior Authorization List, Pg 147 Original policy
J0717Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administerNevada Prior Authorization List, Pg 147 Original policy
J0738Injection, lenacapavir, 1 mg, FDA-approved prescription, only for use as HIV pre- exposure prophylaxis (PrEP) (not for use as treatment for HIV)Nevada Prior Authorization List, Pg 147 Original policy
J0741Injection, cabotegravir and rilpivirine, 2 mg/3 mgNevada Prior Authorization List, Pg 147 Original policy
J0743Cilastatin Sodium InjectionNevada Prior Authorization List, Pg 147 Original policy
J0744Injection, ciprofloxacin for intravenous infusion, 200 mgNevada Prior Authorization List, Pg 147 Original policy
J0752Oral, lenacapavir, 300 mg, FDA-approved prescription, only for use as HIV pre- exposure prophylaxis (PrEP) (not for use as treatment for HIV)Nevada Prior Authorization List, Pg 147 Original policy
J0775Injection, collagenase, clostridium histolyticum, 0.01 mgNevada Prior Authorization List, Pg 147 Original policy
J0791Injection, crizanlizumab-tmca, 5 mgNevada Prior Authorization List, Pg 147 Original policy
J0800Injection, corticotropin, up to 40 unitsNevada Prior Authorization List, Pg 147 Original policy
J0801Injection, corticotropin (Acthar Gel), up to 40 unitsNevada Prior Authorization List, Pg 147 Original policy
J0802Injection, corticotropin (ANI), up to 40 unitsNevada Prior Authorization List, Pg 147 Original policy
J0870Injection, imetelstat, 1 mgNevada Prior Authorization List, Pg 147 Original policy
J0881Injection, darbepoetin alfa, 1 mcg (non-ESRD use)Nevada Prior Authorization List, Pg 147 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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