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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 71

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
J1557Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mgNevada Prior Authorization List, Pg 148 Original policy
J1558Injection, immune globulin (xembify), 100 mgNevada Prior Authorization List, Pg 148 Original policy
J1559Injection, immune globulin (hizentra), 100 mgNevada Prior Authorization List, Pg 149 Original policy
J1560Gamma Globulin > 10 Cc InjNevada Prior Authorization List, Pg 149 Original policy
J1561Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1565Rsv-IvigNevada Prior Authorization List, Pg 149 Original policy
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g.Nevada Prior Authorization List, Pg 149 Original policy
J1569Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1572Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1575Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulinNevada Prior Authorization List, Pg 149 Original policy
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1595Injection, glatiramer acetate, 20 mgNevada Prior Authorization List, Pg 149 Original policy
J1599Injection, immune globulin, intravenous, non-lyophilized (e.g. liquid), not otherwise specified, 500 mgNevada Prior Authorization List, Pg 149 Original policy
J1602Injection, golimumab, 1 mg, for intravenous useNevada Prior Authorization List, Pg 149 Original policy
J1628Injection, guselkumab, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1632Injection, brexanolone, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1743Injection, idursulfase, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1744Injection, icatibant, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1745Injection, infliximab, excludes biosimilar, 10 mgNevada Prior Authorization List, Pg 149 Original policy
J1746Injection, ibalizumab-uiyk, 10 mgNevada Prior Authorization List, Pg 149 Original policy
J1747Injection, spesolimab-sbzo, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1748Injection, infliximab-dyyb (Zymfentra), 10 mgNevada Prior Authorization List, Pg 149 Original policy
J1786Injection, imiglucerase, 10 unitsNevada Prior Authorization List, Pg 149 Original policy
J1809Injection, fosdenopterin, 0.1 mgNevada Prior Authorization List, Pg 149 Original policy
J1823Injection, inebilizumab-cdon, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1826Injection, interferon beta-1a, 30 mcgNevada Prior Authorization List, Pg 149 Original policy
J1830Interferon Beta-1b / .25 MgNevada Prior Authorization List, Pg 149 Original policy
J1930Injection, lanreotide, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1931Laronidase injectionNevada Prior Authorization List, Pg 149 Original policy
J1932Injection, lanreotide, (cipla), 1 mgNevada Prior Authorization List, Pg 149 Original policy
J1950Leuprolide Acetate /3.75 MgNevada Prior Authorization List, Pg 149 Original policy
J1951Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mNevada Prior Authorization List, Pg 149 Original policy
J1954Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mgNevada Prior Authorization List, Pg 149 Original policy
J1956Levofloxacin InjectionNevada Prior Authorization List, Pg 149 Original policy
J1961Injection, lenacapavir (only for use as HIV treatment), 1 mgNevada Prior Authorization List, Pg 149 Original policy
J2170INJECTION, MECASERMIN, 1 MGNevada Prior Authorization List, Pg 149 Original policy
J2182Injection, mepolizumab, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J2183Injection, meropenem (WG Critical Care), not therapeutically equivalent to J2185, 100 mgNevada Prior Authorization List, Pg 149 Original policy
J2184Injection, meropenem (B. Braun), not therapeutically equivalent to J2185, 100 mgNevada Prior Authorization List, Pg 149 Original policy
J2185Injection, meropenem, 100 mgNevada Prior Authorization List, Pg 149 Original policy
J2267Injection, mirikizumab-mrkz, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J2277Injection, motixafortide, 0.25 mgNevada Prior Authorization List, Pg 149 Original policy
J2278Injection, ziconotide, 1 mcgNevada Prior Authorization List, Pg 149 Original policy
J2280Injection, moxifloxacin, 100 mgNevada Prior Authorization List, Pg 149 Original policy
J2281Injection, moxifloxacin (Fresenius Kabi), not therapeutically equivalent to J2280, 100 mgNevada Prior Authorization List, Pg 149 Original policy
J2323Imjection, natalizumab, 1 mgNevada Prior Authorization List, Pg 149 Original policy
J2326Injection, nusinersen, 0.1 mgNevada Prior Authorization List, Pg 149 Original policy
J2327Injection, risankizumab-rzaa, intravenous, 1 mgNevada Prior Authorization List, Pg 150 Original policy
J2329Injection, ublituximab-xiiy, 1mgNevada Prior Authorization List, Pg 150 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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