Anthem Blue Cross and Blue Shield New Hampshire policy
CG-SURG-76 Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty
CG-SURG-76 Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty is a public Anthem Blue Cross and Blue Shield New Hampshire policy (policy CG-SURG-76). It lists 11 CPT or HCPCS codes, 5 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.
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- Policy number
- CG-SURG-76
- 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 |
|---|---|---|---|
| 0075T | Not listed | Policies naming 0075T | |
| 0076T | Not listed | Policies naming 0076T | |
| 37215 | Not listed | Policies naming 37215 | |
| 37216 | On the list | Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection | Policies naming 37216 |
| 37246 | On the list | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery | Policies naming 37246 |
| 61624 | Not listed | Policies naming 61624 | |
| 61630 | Not listed | Policies naming 61630 | |
| 61635 | Not listed | Policies naming 61635 | |
| 61640 | On the list | Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel | Policies naming 61640 |
| 61641 | On the list | Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in same vascular territory (List separately in addition to code for primary procedure) | Policies naming 61641 |
| 61642 | On the list | Balloon dilatation of intracranial vasospasm, percutaneous; each additional vessel in different vascular territory (List separately in addition to code for primary procedure) | Policies naming 61642 |
All Anthem Blue Cross and Blue Shield New Hampshire policies · Anthem Blue Cross and Blue Shield New Hampshire prior authorization CPT list