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Anthem Blue Cross and Blue Shield Nevada prior authorization, page 86

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
S3850Genetic testing for sickle cell anemiaNevada Prior Authorization List, Pg 170 Original policy
S3852DNA analysis for apoe epilson 4 allele for susceptibility to Alzheimer's diseaseNevada Prior Authorization List, Pg 170 Original policy
S3853Genetic testing for myotonic muscular dystrophyNevada Prior Authorization List, Pg 170 Original policy
S3854Gene expression profiling panel for use in the management of breast cancer treatmentNevada Prior Authorization List, Pg 170 Original policy
S3861Genetic testing, sodium channel, voltage-gated, Type V, alpha subunit (SCN5A) and variants for suspected brugada syndromNevada Prior Authorization List, Pg 170 Original policy
S3865Comprehensive gene sequence analysis for hypertrophic cardiomyopathyNevada Prior Authorization List, Pg 170 Original policy
S3866Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (HCM) in an individual with a known HCM muNevada Prior Authorization List, Pg 170 Original policy
S3870Comparative genomic hybridization (cgh) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disabilityNevada Prior Authorization List, Pg 170 Original policy
S3900Surface electromyography (EMG)Nevada Prior Authorization List, Pg 170 Original policy
S8030Scleral application of tantalum ring(s) for localization of lesions for proton beam therapyNevada Prior Authorization List, Pg 170 Original policy
S8035Magnetic Source ImagingNevada Prior Authorization List, Pg 170 Original policy
S8130Interferential current stimulator, 2 channelNevada Prior Authorization List, Pg 170 Original policy
S8131Interferential current stimulator, 4 channelNevada Prior Authorization List, Pg 170 Original policy
S8930Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with patientNevada Prior Authorization List, Pg 170 Original policy
S8940EQUESTRIAN/HIPPOTHERAPY PER SESSIONNevada Prior Authorization List, Pg 170 Original policy
S8948Application of a modality (requiring constant provider attendance) to one orNevada Prior Authorization List, Pg 170 Original policy
S8950Complex Lymphedema TherapyNevada Prior Authorization List, Pg 170 Original policy
S8990Physical or manipulative therapy performed for maintenance rather than restorationNevada Prior Authorization List, Pg 170 Original policy
S9002Intravaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation deviceNevada Prior Authorization List, Pg 170 Original policy
S9056Coma Stimulation Per DiemNevada Prior Authorization List, Pg 170 Original policy
S9090Vertebral Axial DecompressioNevada Prior Authorization List, Pg 170 Original policy
S9123Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codNevada Prior Authorization List, Pg 170 Original policy
S9124Nursing care, in the home; by licensed practical nurse, per hourNevada Prior Authorization List, Pg 170 Original policy
S9152Speech therapy, re-evaluationNevada Prior Authorization List, Pg 171 Original policy
S9364Home infusion therapy, total parenteral nutrition (TPN) (do not use with home infusion codes S9365-S9368 using daily volNevada Prior Authorization List, Pg 171 Original policy
S9365Home infusion therapy, total parenteral nutrition (TPN); one liter per dayNevada Prior Authorization List, Pg 171 Original policy
S9366Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per dayNevada Prior Authorization List, Pg 171 Original policy
S9367Home infusion therapy, total parenteral nutrition (TPN); more than two liter but no more than three liters per dayNevada Prior Authorization List, Pg 171 Original policy
S9368Home infusion therapy, total parenteral nutrition (TPN); more than three liter per dayNevada Prior Authorization List, Pg 171 Original policy
S9480Intensive Outpatient PsychiaNevada Prior Authorization List, Pg 171 Original policy
S9494Home infusion therapy, antibiotic, antiviral, or antifungal therapy (do not use with home infusion codes for hourly dosiNevada Prior Authorization List, Pg 171 Original policy
S9497Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every three hoursNevada Prior Authorization List, Pg 171 Original policy
S9500Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hoursNevada Prior Authorization List, Pg 171 Original policy
S9501Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hoursNevada Prior Authorization List, Pg 171 Original policy
S9502Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hoursNevada Prior Authorization List, Pg 171 Original policy
S9503Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every six hoursNevada Prior Authorization List, Pg 171 Original policy
S9504Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every four hoursNevada Prior Authorization List, Pg 171 Original policy
S9960Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)Nevada Prior Authorization List, Pg 171 Original policy
S9961Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)Nevada Prior Authorization List, Pg 171 Original policy
T1000Private duty/independent nursing service(s) - licensed, up to 15 minutesNevada Prior Authorization List, Pg 171 Original policy
T1002RN services, up to 15 minutesNevada Prior Authorization List, Pg 171 Original policy
T1003LPN/LVN services, up to 15 minutesNevada Prior Authorization List, Pg 171 Original policy
T1030Nursing Care, In The Home, By Registered Nurse, Per DiemNevada Prior Authorization List, Pg 171 Original policy
T1031Nursing Care, In The Home, By Licensed Practical Nurse, Per DiemNevada Prior Authorization List, Pg 171 Original policy
T2036Therapeutic camping, overnight, waiver; each sessionNevada Prior Authorization List, Pg 171 Original policy
T2037Therapeutic camping, day, waiver; each sessionNevada Prior Authorization List, Pg 171 Original policy
V2787Astigmatism correcting function of intraocular lensNevada Prior Authorization List, Pg 171 Original policy
V2788Presbyopia correcting function of intraocular lensNevada Prior Authorization List, Pg 171 Original policy
V2790Amniotic MembraneNevada Prior Authorization List, Pg 171 Original policy
V5095Semi-Implantable Middle Ear Hearing ProsthesisNevada Prior Authorization List, Pg 171 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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