Preauthorization required codes (sample from list)

Examples of CPT codes in this document are marked as requiring preauthorization for Small Employer and Individual plans in Nevada (Preauthorization Required = X).

• 22856, 22857, 22858, 22860, 22861, 22862, 22864, 22865, 23472, 27130, 27279, 27280, 27447, 27702

Not covered codes (sample from list)

Selected CPT codes are explicitly indicated as Not Covered for Small Employer and Individual plans in Nevada (Not Covered = X).

• 22867, 22868, 22869, 22870, 24357, 27278, 28735, 28890

Preauthorization / Not covered flags (sample entries)

The listing includes individual code rows showing either Preauthorization Required = X or Not Covered = X for Small Employer and Individual plans; entries display the flag beside each code.

• 27702 — Preauthorization Required = X
• 28735 — Not Covered = X
• 28890 — Not Covered = X

Preauthorization indicators (per-code)

Per-code entries in the table indicate whether Preauthorization is required (X) or not (–); many codes in the excerpt show Preauthorization Required = X.

• 37200 — Preauthorization Required = X (listed as Transcatheter biopsy)

Transplant/CAR-T related authorization

Transplant and CAR‑T related CPT codes are listed with preauthorization indicators (X) for Small Employer and Individual plans and appear throughout the transplant/CAR‑T sections.

• 38225 — CAR‑T harvesting; Preauthorization Required = X
• 38227 — CAR‑T receipt/preparation; Preauthorization Required = X

Preauthorization required codes (sample)

Additional CPT examples are marked as Preauthorization Required (X) for Small Employer and Individual plans in Nevada.

• 44136, 44137, 44715, 44720, 44721

Liver procedure authorization notes

Selected liver procedure codes show either Preauthorization Required = X or Not Covered = X in the listing for Small Employer and Individual plans.

• 47147 — Backbench reconstruction of cadaver/living donor liver graft; Preauthorization Required = X
• 47382 — Percutaneous radiofrequency ablation of liver tumor; Not Covered = X
• 47384 — Irreversible electroporation liver ablation; Not Covered = X

Prior authorization required for select stereotactic radiosurgery codes

Select stereotactic radiosurgery CPT codes are marked Preauthorization Required = X for Small Employer and Individual plans; the list distinguishes simple vs complex lesions and additional lesion codes.

• 61796 — Stereotactic radiosurgery; 1 simple cranial lesion — Preauthorization Required = X
• 61797 — Each additional simple cranial lesion — Preauthorization Required = X
• 61798/61799 — Complex lesion codes — Preauthorization Required = X
• 61800 — Application of stereotactic headframe — Preauthorization Required = X

Prior authorization required for select spine/pain procedure codes

Multiple spine and pain management procedure codes are listed with Preauthorization Required = X for Small Employer and Individual plans; providers should obtain authorization before billing these services.

• 63030, 63035, 63052, 63053 — decompression/laminotomy/arthrodesis-related codes — Preauthorization Required = X
• 63620, 63621 — Stereotactic spinal radiosurgery — Preauthorization Required = X
• 64490–64495 — Paravertebral facet injections — Preauthorization Required = X
• 64628–64636 — Basivertebral/neurolytic destruction codes — Preauthorization Required = X (64636 explicitly marked X)

Preauthorization requirements (sample)

Code 64636 (destruction by neurolytic agent, lumbar/sacral, each additional facet joint) is specifically marked Preauthorization Required = X for Small Employer and Individual plans.

• 64636 — Preauthorization Required = X

Not covered codes (sample)

Multiple baroreflex activation therapy (BAT) implantation and revision codes are explicitly listed as Not Covered (Not Covered = X) for Small Employer and Individual plans.

• 64654–64659 — Not Covered = X (preauthorization not required)

Imaging preauthorization

Several MRI codes — including functional brain MRI and cardiac MRI codes — are designated Preauthorization Required = X for Small Employer and Individual plans.

• 70554, 70555 — Functional brain MRI — Preauthorization Required = X
• 75557, 75559, 75561 — Cardiac MRI variants — Preauthorization Required = X

Prior authorization required codes (selected)

Several radiation therapy and proton treatment procedure codes are marked Preauthorization Required = X for Small Employer and Individual plans; obtain prior authorization before delivering these services.

• 77435, 77436, 77438, 77520, 77522

Genetic testing prior authorization

Numerous genetic testing codes in the 811xx series are designated Preauthorization Required = X for Small Employer and Individual plans; providers must request authorization for these genetic tests.

• 81165–81167, 81173–81179, 81175–81179 (examples)

Preauthorization required for listed genetic/molecular codes

Multiple listed genetic and molecular CPT codes (single‑gene and microarray tests) are marked with Preauthorization Required = X for Small Employer and Individual plans; authorization is required prior to testing.

• 81209, 81212, 81215, 81216, 81217, 81218

Preauthorization for pharmacogenomic and cytogenomic testing

Pharmacogenomic and cytogenomic testing codes (for example CYP and cytogenomic microarray codes) are flagged Preauthorization Required = X and require prior authorization for Small Employer and Individual plans.

• 81223 (CFTR), 81225 (CYP2C19), 81226 (CYP2D6), 81228 (cytogenomic microarray), 81229

Coverage variance: example not covered vs preauthorization

Some related genetic codes are explicitly Not Covered while other related Lynch syndrome gene tests require preauthorization; verify per‑code status before ordering.

• 81291 — MTHFR common variants — Not Covered = X
• 81292–81296 — MLH1/MSH2 etc. — Preauthorization Required = X

Preauthorization required for listed codes

A broad set of genetic/molecular procedure codes (814xx and related codes) are listed with Preauthorization Required = X for Small Employer and Individual plans; prior authorization is required before claims are considered.

• Examples include 81330, 81333, 81334, 81338, 81339, 81340, 81341, 81342, 81343, 81344, 81345, 81347, 81348, 81349, 81351, 81352, 81354, 81355, 81357

Codes not covered

A small subset of molecular/genomic codes are denoted Not Covered = X in the listing; check each code before ordering to avoid denials.

• 81418 — Drug metabolism/pharmacogenomics panel — Not Covered = X
• 81422 — Fetal chromosomal microdeletion genomic sequence analysis (cell‑free fetal DNA) — Not Covered = x

Genomic/molecular panels preauthorization (sample)

Multiple genomic and molecular panels (81458, 81459, 81460, 81462, 81463, 81464) are listed with Preauthorization Required = X for Small Employer and Individual plans; obtain authorization before ordering panel testing.

• 81458, 81459, 81460, 81462, 81463, 81464

Molecular/oncology codes requiring authorization or not covered

Additional molecular and oncology-related codes are marked either Preauthorization Required = X or Not Covered = X depending on the specific code; consult the table for per‑code guidance.

• 81470, 81471, 81479, 81490, 81493, 81500, 81503–81524 (examples)

Laboratory, reproductive, and specialty procedures authorization flags

Wide ranges of laboratory, reproductive, infectious disease, and specialty procedure codes are listed with either Preauthorization Required = X or Not Covered = X for Small Employer and Individual plans; verify the specific code row.

• Examples: 87183, 82233, 82234, 82777, 83006, 89342, 89343, 89344, 89346

Immunization codes preauth/status

Several vaccine codes are explicitly listed as Not Covered = X for Small Employer and Individual plans; the preauthorization column is present but many immunization entries show '-' (not required).

• 90664, 90666, 90667, 90668, 90690, 90691, 90717

AAC device evaluation/therapy preauth

Evaluation and therapeutic services related to speech‑generating augmentative and alternative communication (AAC) devices are indicated with a preauthorization flag (X*); obtain authorization as noted.

• 92608 — Evaluation for prescription for speech‑generating AAC device — Preauthorization Required = X*
• 92609 — Therapeutic services for speech‑generating device — Preauthorization Required = X*

Preauthorization-required codes

The document marks many CPT/HCPCS codes with Preauthorization Required = X or X* for Small Employer and Individual plans in Nevada; providers must secure prior authorization where the table indicates X or X*.

• 92608, 92609, 92631, 92632, 92635, 92636, 92637, 92638, 92639, 92641, 92921, 92925, 92929, 92934, 92938, 92944, 93025, 93050, 93145, 93146, 93590, 93591, 93592, 93668, 95937, 95957, 94005, 94011, 94012, 94013, 94150, 94452, 94453, 95060, 96000, 96001, 96002, 96004, 96105, 96902, 96904, 96931, 96932, 96933, 96934

Preauthorization requirements — therapy/modality/evaluation codes

Many therapy, modality, and evaluation codes (97xxx, 97xxx series, and therapy CPTs) are marked as requiring preauthorization (X or X*) for Small Employer and Individual plans; obtain prior authorization per the table.

• 97012, 97014, 97016, 97018, 97022, 97024, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97153–97155, 97158, 97161–97167, 97171–97172, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97750, 97755, 97799

Not covered codes

A set of codes are explicitly listed as Not Covered (Not Covered = X) for Small Employer and Individual plans; providers should not expect coverage for these services under the listed plans.

• 96935, 96936, 97007, 97008, 97009, 97010, 97026, 97037, 97150, 97169, 97550–97552, 97602, 97610, 97810–97814, 98001–98006

Preauthorization requirements — chiropractic example

Certain chiropractic manipulation codes (98940–98943) are marked Preauthorization Required = X* for Small Employer and Individual plans; secure prior authorization where indicated.

• 98940, 98941, 98942, 98943 — Preauthorization Required = X*

Preauthorization required example — 99512

CPT 99512 (home visit for hemodialysis, per diem) is specifically marked Preauthorization Required = X for Small Employer and Individual plans; obtain prior authorization before billing.

• 99512 — Preauthorization Required = X

Not covered examples

The listing includes many codes that are Not Covered (marked 'X') for Small Employer and Individual plans; review the per‑code table to identify noncovered services before providing them.

• 99377, 99379, 99380, 99411, 99412 — examples of Not Covered codes