Anthem Blue Cross and Blue Shield Nevada prior authorization, page 85
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
| Code | Description | Source |
|---|---|---|
| Q5157 | Injection, denosumab-bmwo (Stoboclo/Osenvelt), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q5158 | Injection, denosumab-bnht (Bomyntra/Conexxence), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q5159 | Injection, denosumab-dssb (Ospomyv/Xbryk), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q5160 | Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q5162 | Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q9996 | Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q9997 | Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q9998 | Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| Q9999 | Injection, ustekinumab-aauz (Otulfi), biosimilar, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| S0013 | Esketamine, nasal spray, 1 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| S0189 | Testosterone pellet, 75 mg | Nevada Prior Authorization List, Pg 168 Original policy |
| S0196 | Injectable poly-l-lactic acid, restorative implant, 1 ml, face (deep dermis, subcutaneous layers) | Nevada Prior Authorization List, Pg 168 Original policy |
| S0201 | Partial Hospitalization Services, Less Than 24 Hours, Per Diem | Nevada Prior Authorization List, Pg 168 Original policy |
| S0353 | Treatment planning and care coordination management for cancer initial treatment | Nevada Prior Authorization List, Pg 168 Original policy |
| S0354 | Treatment planning and care coordination management for cancer established patient with a change of regimen | Nevada Prior Authorization List, Pg 168 Original policy |
| S1091 | Stent, non-coronary, temporary, with delivery system (propel) | Nevada Prior Authorization List, Pg 168 Original policy |
| S2053 | Transplantation Of Small Int | Nevada Prior Authorization List, Pg 168 Original policy |
| S2054 | Transplantation Of Multivisc | Nevada Prior Authorization List, Pg 168 Original policy |
| S2055 | Harvesting Of Donor Multivis | Nevada Prior Authorization List, Pg 168 Original policy |
| S2060 | Lobar Lung Transplantation | Nevada Prior Authorization List, Pg 168 Original policy |
| S2061 | Donor Lobectomy (Lung) | Nevada Prior Authorization List, Pg 169 Original policy |
| S2065 | Simultaneous pancreas kidney transplantation | Nevada Prior Authorization List, Pg 169 Original policy |
| S2066 | Breast reconstruction with gluteal artery perforator (GAP) flap, including | Nevada Prior Authorization List, Pg 169 Original policy |
| S2067 | Breast reconstruction of a single breast with "stacked" deep inferior | Nevada Prior Authorization List, Pg 169 Original policy |
| S2068 | Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SI | Nevada Prior Authorization List, Pg 169 Original policy |
| S2080 | Laser-assisted uvulopalatoplasty (LAUP) | Nevada Prior Authorization List, Pg 169 Original policy |
| S2102 | Islet Cell Tissue Transplant | Nevada Prior Authorization List, Pg 169 Original policy |
| S2103 | Adrenal Tissue Transplant | Nevada Prior Authorization List, Pg 169 Original policy |
| S2112 | Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells) | Nevada Prior Authorization List, Pg 169 Original policy |
| S2117 | Arthroereisis, subtalar | Nevada Prior Authorization List, Pg 169 Original policy |
| S2118 | Metal-on-metal total hip resurfacing including acetabular and femoral components | Nevada Prior Authorization List, Pg 169 Original policy |
| S2120 | Low Density Lipoprotein(Ldl) | Nevada Prior Authorization List, Pg 169 Original policy |
| S2140 | Cord Blood Harvesting | Nevada Prior Authorization List, Pg 169 Original policy |
| S2142 | Cord Blood-Derived Stem-Cell | Nevada Prior Authorization List, Pg 169 Original policy |
| S2150 | Bone marrow or blood-derived peripheral stem cell harvesting and transplantation, allogenic or autologous, including phe | Nevada Prior Authorization List, Pg 169 Original policy |
| S2202 | Echosclerotherapy | Nevada Prior Authorization List, Pg 169 Original policy |
| S2230 | Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear | Nevada Prior Authorization List, Pg 169 Original policy |
| S2235 | Implantation of auditory brain stem implant | Nevada Prior Authorization List, Pg 169 Original policy |
| S2300 | Arthroscopy, Shoulder, Surgi | Nevada Prior Authorization List, Pg 169 Original policy |
| S2342 | Nasal endoscopy for post-operative debridement following functional endoscopic sinus surgery, nasal and/or sinus cavity( | Nevada Prior Authorization List, Pg 169 Original policy |
| S2348 | Decompress disc RF lumbar | Nevada Prior Authorization List, Pg 169 Original policy |
| S3800 | Genetic testing for amyotrophic lateral sclerosis (ALS) | Nevada Prior Authorization List, Pg 169 Original policy |
| S3840 | DNA analysis for germline mutations of the ret proto-oncogene | Nevada Prior Authorization List, Pg 169 Original policy |
| S3841 | Genetic testing for retinoblastoma | Nevada Prior Authorization List, Pg 169 Original policy |
| S3842 | Genetic testing for von hippel-lindau disease | Nevada Prior Authorization List, Pg 169 Original policy |
| S3844 | DNA analysis of the connexin 26 gene (gjb2) for susceptibility to congenital, profound deafness | Nevada Prior Authorization List, Pg 170 Original policy |
| S3845 | Genetic testing for alpha-thalassemia | Nevada Prior Authorization List, Pg 170 Original policy |
| S3846 | Genetic testing for hemoglobin e beta-thalassemia | Nevada Prior Authorization List, Pg 170 Original policy |
| S3849 | Genetic testing for niemann-pick disease | Nevada Prior Authorization List, Pg 170 Original policy |