Anthem Blue Cross and Blue Shield New Hampshire policy
CG-MED-102 Dichoptic Digital Therapy for Amblyopia
CG-MED-102 Dichoptic Digital Therapy for Amblyopia is a public Anthem Blue Cross and Blue Shield New Hampshire policy (policy CG-MED-102). It lists 6 CPT or HCPCS codes, 6 of them on the Anthem Blue Cross and Blue Shield New Hampshire 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
- CG-MED-102
- 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 New Hampshire prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield New Hampshire policies |
|---|---|---|---|
| 0687T | On the list | Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session | Policies naming 0687T |
| 0688T | On the list | Treatment of amblyopia using an online digital program; assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month | Policies naming 0688T |
| 0704T | On the list | Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment | Policies naming 0704T |
| 0705T | On the list | Remote treatment of amblyopia using an eye tracking device; surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days | Policies naming 0705T |
| 0706T | On the list | Remote treatment of amblyopia using an eye tracking device; interpretation and report by physician or other qualified health care professional, per calendar month | Policies naming 0706T |
| A9292 | On the list | Prescription digital visual therapy, software-only, FDA cleared, per course of treatment | Policies naming A9292 |
All Anthem Blue Cross and Blue Shield New Hampshire policies · Anthem Blue Cross and Blue Shield New Hampshire prior authorization CPT list