Anthem Blue Cross and Blue Shield Nevada policy
CG-SURG-51 Outpatient Cystourethroscopy
CG-SURG-51 Outpatient Cystourethroscopy is a public Anthem Blue Cross and Blue Shield Nevada policy (policy CG-SURG-51). It lists 18 CPT or HCPCS codes, 13 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
- CG-SURG-51
- 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 |
|---|---|---|---|
| 52000 | On the list | Cystourethroscopy (Sep Proc) | Policies naming 52000 |
| 52001 | On the list | Cystourethroscopy W/Irrigation & Evacuation Clots | Policies naming 52001 |
| 52005 | On the list | Cystourethroscopy, W/Ureteral Catheterization | Policies naming 52005 |
| 52007 | On the list | Cystourethroscopy, W/Ureteral Catheterization; W/Brush Bx, Ureter &/Or Renal Pelvis | Policies naming 52007 |
| 52010 | Not listed | Policies naming 52010 | |
| 52204 | On the list | Cystourethroscopy, with biopsy(s) | Policies naming 52204 |
| 52214 | On the list | Cystourethroscopy, W/Fulguration Trigone/Bladder Neck/Prostate/Urethra/Glands | Policies naming 52214 |
| 52224 | On the list | Cystourethroscopy, W/Fulguration/Treatment Lesion(S) < 0.5 Cm, W/Wo Bx | Policies naming 52224 |
| 52234 | On the list | Cystourethroscopy, W/Fulguration &/Or Resection; Bladder Tumor(S) 0.5-2.0 Cm | Policies naming 52234 |
| 52235 | On the list | Cystourethroscopy, W/Fulguration &/Or Resection; Bladder Tumor(S) 2.0-5.0 Cm | Policies naming 52235 |
| 52240 | On the list | Cystourethroscopy, W/Fulguration &/Or Resection; Large Bladder Tumor(S) > 5.0 Cm | Policies naming 52240 |
| 52250 | Not listed | Policies naming 52250 | |
| 52260 | On the list | Cystourethroscopy, W/Dilation, Bladder, Interstitial Cystitis; General/Spinal Anesthesia | Policies naming 52260 |
| 52265 | On the list | Cystourethroscopy, W/Dilation, Bladder, Interstitial Cystitis; Local Anesthesia | Policies naming 52265 |
| 52270 | Not listed | Policies naming 52270 | |
| 52275 | On the list | Cystourethroscopy, W/Int Urethrotomy; Male | Policies naming 52275 |
| C7550 | Not listed | Policies naming C7550 | |
| C7554 | Not listed | Policies naming C7554 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list