Anthem Blue Cross and Blue Shield Nevada policy
CG-MED-23 Home Health
CG-MED-23 Home Health is a public Anthem Blue Cross and Blue Shield Nevada policy (policy CG-MED-23). It lists 128 CPT or HCPCS codes, 19 of them on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- CG-MED-23
- 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 |
|---|---|---|---|
| 99500 | Not listed | Policies naming 99500 | |
| 99503 | Not listed | Policies naming 99503 | |
| 99504 | Not listed | Policies naming 99504 | |
| 99505 | Not listed | Policies naming 99505 | |
| 99506 | Not listed | Policies naming 99506 | |
| 99507 | Not listed | Policies naming 99507 | |
| 99509 | Not listed | Policies naming 99509 | |
| 99511 | Not listed | Policies naming 99511 | |
| 99512 | Not listed | Policies naming 99512 | |
| 99600 | Not listed | Policies naming 99600 | |
| 99601 | Not listed | Policies naming 99601 | |
| 99602 | Not listed | Policies naming 99602 | |
| G0068 | Not listed | Policies naming G0068 | |
| G0069 | Not listed | Policies naming G0069 | |
| G0070 | Not listed | Policies naming G0070 | |
| G0088 | Not listed | Policies naming G0088 | |
| G0089 | Not listed | Policies naming G0089 | |
| G0090 | Not listed | Policies naming G0090 | |
| G0151 | Not listed | Policies naming G0151 | |
| G0152 | Not listed | Policies naming G0152 | |
| G0153 | Not listed | Policies naming G0153 | |
| G0155 | Not listed | Policies naming G0155 | |
| G0156 | Not listed | Policies naming G0156 | |
| G0157 | Not listed | Policies naming G0157 | |
| G0158 | Not listed | Policies naming G0158 | |
| G0159 | Not listed | Policies naming G0159 | |
| G0160 | Not listed | Policies naming G0160 | |
| G0161 | Not listed | Policies naming G0161 | |
| G0162 | Not listed | Policies naming G0162 | |
| G0299 | Not listed | Policies naming G0299 | |
| G0300 | Not listed | Policies naming G0300 | |
| G0320 | Not listed | Policies naming G0320 | |
| G0321 | Not listed | Policies naming G0321 | |
| G0322 | Not listed | Policies naming G0322 | |
| G0493 | Not listed | Policies naming G0493 | |
| G0494 | Not listed | Policies naming G0494 | |
| G0495 | Not listed | Policies naming G0495 | |
| G0496 | Not listed | Policies naming G0496 | |
| G2168 | On the list | Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes | Policies naming G2168 |
| G2169 | Not listed | Policies naming G2169 | |
| Q5001 | Not listed | Policies naming Q5001 | |
| Q5002 | Not listed | Policies naming Q5002 | |
| Q5009 | Not listed | Policies naming Q5009 | |
| S5035 | Not listed | Policies naming S5035 | |
| S5036 | Not listed | Policies naming S5036 | |
| S5108 | Not listed | Policies naming S5108 | |
| S5109 | Not listed | Policies naming S5109 | |
| S5110 | Not listed | Policies naming S5110 | |
| S5111 | Not listed | Policies naming S5111 | |
| S5115 | Not listed | Policies naming S5115 | |
| S5116 | Not listed | Policies naming S5116 | |
| S5180 | Not listed | Policies naming S5180 | |
| S5181 | Not listed | Policies naming S5181 | |
| S5497 | Not listed | Policies naming S5497 | |
| S5498 | Not listed | Policies naming S5498 | |
| S5501 | Not listed | Policies naming S5501 | |
| S5502 | Not listed | Policies naming S5502 | |
| S5517 | Not listed | Policies naming S5517 | |
| S5518 | Not listed | Policies naming S5518 | |
| S5520 | Not listed | Policies naming S5520 | |
| S5521 | Not listed | Policies naming S5521 | |
| S5522 | Not listed | Policies naming S5522 | |
| S5523 | Not listed | Policies naming S5523 | |
| S9061 | Not listed | Policies naming S9061 | |
| S9097 | Not listed | Policies naming S9097 | |
| S9122 | Not listed | Policies naming S9122 | |
| S9123 | On the list | Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT cod | Policies naming S9123 |
| S9124 | On the list | Nursing care, in the home; by licensed practical nurse, per hour | Policies naming S9124 |
| S9127 | Not listed | Policies naming S9127 | |
| S9128 | Not listed | Policies naming S9128 | |
| S9129 | Not listed | Policies naming S9129 | |
| S9131 | Not listed | Policies naming S9131 | |
| S9209 | Not listed | Policies naming S9209 | |
| S9211 | Not listed | Policies naming S9211 | |
| S9212 | Not listed | Policies naming S9212 | |
| S9213 | Not listed | Policies naming S9213 | |
| S9214 | Not listed | Policies naming S9214 | |
| S9325 | Not listed | Policies naming S9325 | |
| S9326 | Not listed | Policies naming S9326 | |
| S9327 | Not listed | Policies naming S9327 | |
| S9328 | Not listed | Policies naming S9328 | |
| S9329 | Not listed | Policies naming S9329 | |
| S9330 | Not listed | Policies naming S9330 | |
| S9331 | Not listed | Policies naming S9331 | |
| S9336 | Not listed | Policies naming S9336 | |
| S9338 | Not listed | Policies naming S9338 | |
| S9345 | Not listed | Policies naming S9345 | |
| S9346 | Not listed | Policies naming S9346 | |
| S9348 | Not listed | Policies naming S9348 | |
| S9351 | Not listed | Policies naming S9351 | |
| S9353 | Not listed | Policies naming S9353 | |
| S9357 | Not listed | Policies naming S9357 | |
| S9361 | Not listed | Policies naming S9361 | |
| S9363 | Not listed | Policies naming S9363 | |
| S9364 | On the list | Home infusion therapy, total parenteral nutrition (TPN) (do not use with home infusion codes S9365-S9368 using daily vol | Policies naming S9364 |
| S9365 | On the list | Home infusion therapy, total parenteral nutrition (TPN); one liter per day | Policies naming S9365 |
| S9366 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per day | Policies naming S9366 |
| S9367 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than two liter but no more than three liters per day | Policies naming S9367 |
| S9368 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than three liter per day | Policies naming S9368 |
| S9370 | Not listed | Policies naming S9370 | |
| S9372 | Not listed | Policies naming S9372 | |
| S9373 | Not listed | Policies naming S9373 | |
| S9374 | Not listed | Policies naming S9374 | |
| S9375 | Not listed | Policies naming S9375 | |
| S9376 | Not listed | Policies naming S9376 | |
| S9377 | Not listed | Policies naming S9377 | |
| S9379 | Not listed | Policies naming S9379 | |
| S9490 | Not listed | Policies naming S9490 | |
| S9494 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy (do not use with home infusion codes for hourly dosi | Policies naming S9494 |
| S9497 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every three hours | Policies naming S9497 |
| S9500 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours | Policies naming S9500 |
| S9501 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours | Policies naming S9501 |
| S9502 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours | Policies naming S9502 |
| S9503 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every six hours | Policies naming S9503 |
| S9504 | On the list | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every four hours | Policies naming S9504 |
| S9538 | Not listed | Policies naming S9538 | |
| S9542 | Not listed | Policies naming S9542 | |
| S9560 | Not listed | Policies naming S9560 | |
| S9590 | Not listed | Policies naming S9590 | |
| S9810 | Not listed | Policies naming S9810 | |
| T1001 | Not listed | Policies naming T1001 | |
| T1002 | On the list | RN services, up to 15 minutes | Policies naming T1002 |
| T1003 | On the list | LPN/LVN services, up to 15 minutes | Policies naming T1003 |
| T1004 | Not listed | Policies naming T1004 | |
| T1021 | Not listed | Policies naming T1021 | |
| T1022 | Not listed | Policies naming T1022 | |
| T1030 | On the list | Nursing Care, In The Home, By Registered Nurse, Per Diem | Policies naming T1030 |
| T1031 | On the list | Nursing Care, In The Home, By Licensed Practical Nurse, Per Diem | Policies naming T1031 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list