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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 84

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
Q5105Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for ESRD on dialysis), 100 unitsNevada Prior Authorization List, Pg 167 Original policy
Q5106Injection, epoetin alfa-epbx, biosimilar, (Retacrit) (for non-ESRD use), 1000 unitsNevada Prior Authorization List, Pg 167 Original policy
Q5107Injection, bevacizumab-awwb, biosimilar, (Mvasi), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5109Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgramNevada Prior Authorization List, Pg 167 Original policy
Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5112Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5113Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5114Injection, trastuzumab-dkst, biosimilar, (Ogivri), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5115Injection, rituximab-abbs, biosimilar, 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5116Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5118Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5119Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5120Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5121Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5122Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5123Injection, rituximab-arrx, biosimilar, (riabni), 10 mNevada Prior Authorization List, Pg 167 Original policy
Q5124Injection, ranibizumab-nuna, biosimilar, (Byooviz), 0.1 mgNevada Prior Authorization List, Pg 167 Original policy
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgramNevada Prior Authorization List, Pg 167 Original policy
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5127Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mgNevada Prior Authorization List, Pg 167 Original policy
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mgNevada Prior Authorization List, Pg 167 Original policy
Q5130Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mgNevada Prior Authorization List, Pg 167 Original policy
Q5131Injection, adalimumab-aacf (idacio), biosimilar, 20 mgNevada Prior Authorization List, Pg 168 Original policy
Q5132Injection, adalimumab-afzb (abrilada), biosimilar, 10 mgNevada Prior Authorization List, Pg 168 Original policy
Q5133Injection, tocilizumab-bavi (Tofidence), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5134Injection, natalizumab-sztn (Tyruko), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5135Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5136Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5137Injection, ustekinumab-auub (Wezlana), biosimilar, SC, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5138Injection, ustekinumab-auub (Wezlana), biosimilar, IV, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5140Injection, adalimumab-fkjp, biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5141Injection, adalimumab-aaty, biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5142Injection, adalimumab-ryvk biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5143Injection, adalimumab-adbm, biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5144Injection, adalimumab-aacf (idacio), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5145Injection, adalimumab-afzb (abrilada), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5146Injection, trastuzumab-strf (hercessi), biosimilar, 10 mgNevada Prior Authorization List, Pg 168 Original policy
Q5147Injection, aflibercept-ayyh (Pavblu), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5148Injection, filgrastim-txid (Nypozi), biosimilar, 1 mcgNevada Prior Authorization List, Pg 168 Original policy
Q5149Injection, aflibercept-abzv (Enzeevu), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5150Injection, aflibercept-mrbb (Ahzantive), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5151Injection, eculizumab-aagh (Epysqli), biosimilar, 2 mgNevada Prior Authorization List, Pg 168 Original policy
Q5152Injection, eculizumab-aeeb (Bkemv), biosimilar, 2 mgNevada Prior Authorization List, Pg 168 Original policy
Q5153Injection, aflibercept-yszy (opuviz), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5154Injection, omalizumab-igec (Omlyclo), biosimilar, 5 mgNevada Prior Authorization List, Pg 168 Original policy
Q5155Injection, aflibercept-jbvf (Yesafili), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 Original policy
Q5156Injection, tocilizumab-anoh (Avtozma), biosimilar, 1 mgNevada Prior Authorization List, Pg 168 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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