Anthem Blue Cross and Blue Shield Nevada policy
SURG.00165 Histotripsy
SURG.00165 Histotripsy is a public Anthem Blue Cross and Blue Shield Nevada policy (policy SURG.00165). It lists 5 CPT or HCPCS codes, 2 of them on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage decision; the payer's own document governs.
Check eligibility for free
No account required. Sign a BAA to see plan details, coordination of benefits and more
- Policy number
- SURG.00165
- 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 |
|---|---|---|---|
| 0686T | On the list | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance | Policies naming 0686T |
| 0888T | On the list | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance | Policies naming 0888T |
| 1037T | Not listed | Policies naming 1037T | |
| 47399 | Not listed | Policies naming 47399 | |
| 55899 | Not listed | Policies naming 55899 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list