Anthem Blue Cross and Blue Shield Nevada policy
ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck
ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck is a public Anthem Blue Cross and Blue Shield Nevada policy (policy ANC.00008). It lists 61 CPT or HCPCS codes, 55 of them on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- ANC.00008
- Line of business
- Commercial
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross and Blue Shield Nevada prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Nevada policies |
|---|---|---|---|
| 00007 | Not listed | Policies naming 00007 | |
| 00008 | Not listed | Policies naming 00008 | |
| 00009 | Not listed | Policies naming 00009 | |
| 00096 | Not listed | Policies naming 00096 | |
| 15824 | On the list | Rhytidectomy; Forehead | Policies naming 15824 |
| 15825 | On the list | Rhytidectomy; Neck W/Platysmal Tightening (Platysmal Flap, P-Flap) | Policies naming 15825 |
| 15826 | On the list | Rhytidectomy; Glabellar Frown Lines | Policies naming 15826 |
| 15828 | On the list | Rhytidectomy; Cheek, Chin, & Neck | Policies naming 15828 |
| 15829 | On the list | Rhytidectomy; Superficial Musculoaponeurotic System (Smas) Flap | Policies naming 15829 |
| 15838 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad | Policies naming 15838 |
| 15840 | On the list | Graft, Facial Nerve Paralysis; Free Fascia Graft (W/Obtaining Fascia) | Policies naming 15840 |
| 15841 | On the list | Graft, Facial Nerve Paralysis; Free Muscle Graft (W/Obtaining Graft) | Policies naming 15841 |
| 15842 | On the list | Graft, Facial Nerve Paralysis; Free Muscle Flap, Microsurgical Technique | Policies naming 15842 |
| 15845 | On the list | Graft, Facial Nerve Paralysis; Regional Muscle Transfer | Policies naming 15845 |
| 15876 | On the list | Suction Assisted Lipectomy; Head & Neck | Policies naming 15876 |
| 21083 | On the list | Impression & Custom Preparation; Palatal Lift Prosthesis | Policies naming 21083 |
| 21086 | On the list | Impression & Custom Preparation; Auricular Prosthesis | Policies naming 21086 |
| 21087 | On the list | Impression & Custom Preparation; Nasal Prosthesis | Policies naming 21087 |
| 21137 | On the list | Reduction Forehead; Contouring Only | Policies naming 21137 |
| 21138 | On the list | Reduction Forehead; Contouring/Prosthesis/Bone Graft W/Obtaining Autograft | Policies naming 21138 |
| 21139 | On the list | Reduction Forehead; Contouring & Setback, Anterior Frontal Sinus Wall | Policies naming 21139 |
| 21159 | On the list | Reconstruction Midface, Lefort Iii, (Extra/Intracranial), W/Bone Grafts, W/O Lefort I | Policies naming 21159 |
| 21160 | On the list | Reconstruction Midface, Lefort Iii, (Extra/Intracranial), W/Bone Grafts, W/Lefort I | Policies naming 21160 |
| 21172 | On the list | Reconstruction Superior-Lateral Orbital Rim & Lower Forehead | Policies naming 21172 |
| 21175 | On the list | Reconstruction, Bifrontal,Superior-Lateral Orbital Rims & Lower Forehead | Policies naming 21175 |
| 21179 | On the list | Reconstruction, Majority, Forehead & Supraorbital Rims; W/Grafts (Allograft/Prosthetic) | Policies naming 21179 |
| 21180 | On the list | Reconstruction, Majority, Forehead & Supraorbital Rims; W/Autograft | Policies naming 21180 |
| 21182 | On the list | Reconstruction, Orbit/Forehead/Nasoethmoid, Following Excision, Benign Tumor, Graft < 40 Sq Cm | Policies naming 21182 |
| 21183 | On the list | Reconstruction, Orbit/Forehead/Nasoethmiod, Following Excision, Benign Tumor, Graft 40-80 Sq Cm | Policies naming 21183 |
| 21184 | On the list | Reconstruction, Orbit/Forehead/Nasoethmoid, Following Excision, Benign Tumor, Graft > 80 Sq Cm | Policies naming 21184 |
| 21210 | On the list | Graft, Bone; Nasal, Maxillary/Malar Areas (Includes Obtaining Graft) | Policies naming 21210 |
| 21230 | On the list | Graft; Rib Cartilage, Autogenous, Face/Chin/Nose/Ear (Includes Obtaining Graft) | Policies naming 21230 |
| 21235 | On the list | Graft; Ear Cartilage, Autogenous, Nose/Ear (Includes Obtaining Graft) | Policies naming 21235 |
| 21255 | On the list | Reconstruction, Zygomatic Arch/Glenoid Fossa W/Bone & Cartilage (Includes Obtaining Autografts) | Policies naming 21255 |
| 21256 | On the list | Reconstruction, Orbit W/Osteotomies & Bone Grafts (Includes Obtaining Autografts) | Policies naming 21256 |
| 21270 | On the list | Malar Augmentation, Prosthetic Matl | Policies naming 21270 |
| 21275 | On the list | Secondary Revision, Orbitocraniofacial Reconstruction | Policies naming 21275 |
| 30120 | On the list | Excision/Surgical Planing, Skin, Nose, Rhinophyma | Policies naming 30120 |
| 30400 | On the list | Rhinoplasty, Primary; Lateral & Alar Cartilages &/Or Elevation, Nasal Tip | Policies naming 30400 |
| 30410 | On the list | Rhinoplasty, Primary; Complete, Ext Parts W/Bony Pyramid, Lat & Alar Cartilages &/Or Elev Nasal Tip | Policies naming 30410 |
| 30420 | On the list | Rhinoplasty, Primary; W/Major Septal Repair | Policies naming 30420 |
| 30430 | On the list | Rhinoplasty, Secondary; Minor Revision (Small Amount, Nasal Tip Work) | Policies naming 30430 |
| 30435 | On the list | Rhinoplasty, Secondary; Intermediate Revision (Bony Work W/Osteotomies) | Policies naming 30435 |
| 30450 | On the list | Rhinoplasty, Secondary; Major Revision (Nasal Tip Work & Osteotomies) | Policies naming 30450 |
| 64716 | On the list | Neuroplasty &/Or Transposition; Cranial Nerve (Specify) | Policies naming 64716 |
| 64732 | On the list | Transection/Avulsion; Supraorbital Nerve | Policies naming 64732 |
| 64734 | On the list | Transection/Avulsion; Infraorbital Nerve | Policies naming 64734 |
| 64736 | On the list | Transection/Avulsion; Mental Nerve | Policies naming 64736 |
| 64738 | On the list | Transection/Avulsion; Inferior Alveolar Nerve, Osteotomy | Policies naming 64738 |
| 64740 | On the list | Transection/Avulsion; Lingual Nerve | Policies naming 64740 |
| 64742 | On the list | Transection/Avulsion; Facial Nerve, Differential/Complete | Policies naming 64742 |
| 64864 | On the list | Suture, Facial Nerve; Extracranial | Policies naming 64864 |
| 64865 | On the list | Suture, Facial Nerve; Infratemporal, W/Wo Grafting | Policies naming 64865 |
| 64866 | On the list | Anastomosis; Facial-Spinal Accessory | Policies naming 64866 |
| 64868 | On the list | Anastomosis; Facial-Hypoglossal | Policies naming 64868 |
| 69090 | On the list | Ear Piercing | Policies naming 69090 |
| 69300 | On the list | Otoplasty, Protruding Ear, W/Wo Size Reduction | Policies naming 69300 |
| 69399 | Not listed | Policies naming 69399 | |
| 69955 | On the list | Total Facial Nerve Decompression &/Or Repair, (May Include Graft) | Policies naming 69955 |
| L8045 | On the list | Auricular Prosthesis | Policies naming L8045 |
| L8699 | Not listed | Policies naming L8699 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list