Anthem Blue Cross and Blue Shield New Hampshire policy
Global Surgical Package - Professional
Global Surgical Package - Professional is a public Anthem Blue Cross and Blue Shield New Hampshire policy (policy C-08007, effective Jun 14, 2023). It lists 159 CPT or HCPCS codes, 24 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
- C-08007
- Effective
- Jun 14, 2023
- Line of business
- Commercial
- States
- CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI
- 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 |
|---|---|---|---|
| 0335T | On the list | Insertion of sinus tarsi implant | Policies naming 0335T |
| 0343T | Not listed | Policies naming 0343T | |
| 0344T | Not listed | Policies naming 0344T | |
| 0345T | On the list | Transcatheter mitral valve repair percutaneous approach via the coronary sinus | Policies naming 0345T |
| 0440T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0440T |
| 0441T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0441T |
| 0442T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0442T |
| 0444T | Not listed | Policies naming 0444T | |
| 0445T | Not listed | Policies naming 0445T | |
| 0446T | Not listed | Policies naming 0446T | |
| 0447T | Not listed | Policies naming 0447T | |
| 0448T | Not listed | Policies naming 0448T | |
| 0466T | Not listed | Policies naming 0466T | |
| 0467T | Not listed | Policies naming 0467T | |
| 0468T | Not listed | Policies naming 0468T | |
| 0510T | On the list | Removal of sinus tarsi implant | Policies naming 0510T |
| 0511T | On the list | Removal and reinsertion of sinus tarsi implant | Policies naming 0511T |
| 0567T | Not listed | Policies naming 0567T | |
| 0568T | Not listed | Policies naming 0568T | |
| 0571T | On the list | Insertion or replacement of implantable ca | Policies naming 0571T |
| 0572T | On the list | Insertion of substernal implantable defibrill | Policies naming 0572T |
| 0573T | On the list | Removal of substernal implantable defibrill | Policies naming 0573T |
| 0574T | On the list | Repositioning of previously implanted sub | Policies naming 0574T |
| 0580T | On the list | Removal of substernal implantable defibrill | Policies naming 0580T |
| 0583T | Not listed | Policies naming 0583T | |
| 0585T | On the list | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; laparoscopic | Policies naming 0585T |
| 0588T | On the list | Revision or removal of percutaneously placed integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve | Policies naming 0588T |
| 0594T | Not listed | Policies naming 0594T | |
| 0596T | On the list | Temporary female intraurethral valve- pump (ie, voiding prosthesis); initial insertion, including urethral measurement | Policies naming 0596T |
| 0597T | On the list | Temporary female intraurethral valve- pump (ie, voiding prosthesis); replacement | Policies naming 0597T |
| 0600T | On the list | Ablation, irreversible electroporation; 1 or more tumors per organ, including imaging guidance, when performed, percutaneous | Policies naming 0600T |
| 0601T | On the list | Ablation, irreversible electroporation; 1 or more tumors per organ, including fluoroscopic and ultrasound guidance, when performed, open | Policies naming 0601T |
| 0614T | Not listed | Policies naming 0614T | |
| 0619T | Not listed | Policies naming 0619T | |
| 0621T | Not listed | Policies naming 0621T | |
| 0622T | Not listed | Policies naming 0622T | |
| 0627T | On the list | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level | Policies naming 0627T |
| 0629T | On the list | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level | Policies naming 0629T |
| 0644T | Not listed | Policies naming 0644T | |
| 0647T | Not listed | Policies naming 0647T | |
| 0655T | On the list | Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with MR- fused images or other enhanced ultrasound imaging | Policies naming 0655T |
| 0660T | Not listed | Policies naming 0660T | |
| 0661T | Not listed | Policies naming 0661T | |
| 0672T | On the list | Endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence | Policies naming 0672T |
| 0673T | On the list | Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance | Policies naming 0673T |
| 0677T | Not listed | Policies naming 0677T | |
| 0679T | Not listed | Policies naming 0679T | |
| 0680T | Not listed | Policies naming 0680T | |
| 0681T | Not listed | Policies naming 0681T | |
| 0682T | Not listed | Policies naming 0682T | |
| 0699T | Not listed | Policies naming 0699T | |
| 0714T | Not listed | Policies naming 0714T | |
| 0730T | Not listed | Policies naming 0730T | |
| 0737T | Not listed | Policies naming 0737T | |
| 08007 | Not listed | Policies naming 08007 | |
| 10060 | Not listed | Policies naming 10060 | |
| 10061 | Not listed | Policies naming 10061 | |
| 10140 | Not listed | Policies naming 10140 | |
| 10160 | Not listed | Policies naming 10160 | |
| 10180 | Not listed | Policies naming 10180 | |
| 15999 | Not listed | Policies naming 15999 | |
| 17999 | Not listed | Policies naming 17999 | |
| 19499 | Not listed | Policies naming 19499 | |
| 20999 | Not listed | Policies naming 20999 | |
| 21089 | Not listed | Policies naming 21089 | |
| 21299 | Not listed | Policies naming 21299 | |
| 21499 | Not listed | Policies naming 21499 | |
| 21899 | Not listed | Policies naming 21899 | |
| 22899 | Not listed | Policies naming 22899 | |
| 22999 | Not listed | Policies naming 22999 | |
| 23004 | Not listed | Policies naming 23004 | |
| 23929 | Not listed | Policies naming 23929 | |
| 24999 | Not listed | Policies naming 24999 | |
| 25999 | Not listed | Policies naming 25999 | |
| 26989 | Not listed | Policies naming 26989 | |
| 27299 | Not listed | Policies naming 27299 | |
| 27599 | Not listed | Policies naming 27599 | |
| 27899 | Not listed | Policies naming 27899 | |
| 28899 | Not listed | Policies naming 28899 | |
| 29999 | Not listed | Policies naming 29999 | |
| 30999 | Not listed | Policies naming 30999 | |
| 31299 | Not listed | Policies naming 31299 | |
| 32999 | Not listed | Policies naming 32999 | |
| 33999 | Not listed | Policies naming 33999 | |
| 34841 | Not listed | Policies naming 34841 | |
| 34842 | Not listed | Policies naming 34842 | |
| 34843 | Not listed | Policies naming 34843 | |
| 34844 | Not listed | Policies naming 34844 | |
| 34845 | Not listed | Policies naming 34845 | |
| 34846 | Not listed | Policies naming 34846 | |
| 34847 | Not listed | Policies naming 34847 | |
| 34848 | Not listed | Policies naming 34848 | |
| 36299 | Not listed | Policies naming 36299 | |
| 37501 | Not listed | Policies naming 37501 | |
| 37799 | Not listed | Policies naming 37799 | |
| 38129 | Not listed | Policies naming 38129 | |
| 38589 | Not listed | Policies naming 38589 | |
| 38999 | Not listed | Policies naming 38999 | |
| 39499 | Not listed | Policies naming 39499 | |
| 39599 | Not listed | Policies naming 39599 | |
| 40799 | Not listed | Policies naming 40799 | |
| 40899 | Not listed | Policies naming 40899 | |
| 41599 | Not listed | Policies naming 41599 | |
| 41899 | Not listed | Policies naming 41899 | |
| 42299 | Not listed | Policies naming 42299 | |
| 42699 | Not listed | Policies naming 42699 | |
| 42999 | Not listed | Policies naming 42999 | |
| 43659 | Not listed | Policies naming 43659 | |
| 43999 | On the list | Unlisted procedure, stomach | Policies naming 43999 |
| 44238 | Not listed | Policies naming 44238 | |
| 44799 | Not listed | Policies naming 44799 | |
| 44899 | Not listed | Policies naming 44899 | |
| 44979 | Not listed | Policies naming 44979 | |
| 45499 | Not listed | Policies naming 45499 | |
| 46999 | Not listed | Policies naming 46999 | |
| 47379 | Not listed | Policies naming 47379 | |
| 47399 | Not listed | Policies naming 47399 | |
| 47579 | Not listed | Policies naming 47579 | |
| 47999 | Not listed | Policies naming 47999 | |
| 48999 | Not listed | Policies naming 48999 | |
| 49329 | Not listed | Policies naming 49329 | |
| 49659 | Not listed | Policies naming 49659 | |
| 49999 | Not listed | Policies naming 49999 | |
| 50549 | Not listed | Policies naming 50549 | |
| 50949 | Not listed | Policies naming 50949 | |
| 51700 | Not listed | Policies naming 51700 | |
| 51999 | Not listed | Policies naming 51999 | |
| 53899 | Not listed | Policies naming 53899 | |
| 55559 | Not listed | Policies naming 55559 | |
| 55899 | Not listed | Policies naming 55899 | |
| 58578 | Not listed | Policies naming 58578 | |
| 58679 | Not listed | Policies naming 58679 | |
| 58999 | Not listed | Policies naming 58999 | |
| 59400 | Not listed | Policies naming 59400 | |
| 59410 | Not listed | Policies naming 59410 | |
| 59510 | Not listed | Policies naming 59510 | |
| 59515 | Not listed | Policies naming 59515 | |
| 59610 | Not listed | Policies naming 59610 | |
| 59614 | Not listed | Policies naming 59614 | |
| 59618 | Not listed | Policies naming 59618 | |
| 59622 | Not listed | Policies naming 59622 | |
| 59898 | Not listed | Policies naming 59898 | |
| 59899 | Not listed | Policies naming 59899 | |
| 60659 | Not listed | Policies naming 60659 | |
| 60699 | Not listed | Policies naming 60699 | |
| 64999 | Not listed | Policies naming 64999 | |
| 66999 | Not listed | Policies naming 66999 | |
| 67299 | Not listed | Policies naming 67299 | |
| 67599 | Not listed | Policies naming 67599 | |
| 67999 | Not listed | Policies naming 67999 | |
| 68399 | Not listed | Policies naming 68399 | |
| 68899 | Not listed | Policies naming 68899 | |
| 69399 | Not listed | Policies naming 69399 | |
| 69799 | Not listed | Policies naming 69799 | |
| 69949 | Not listed | Policies naming 69949 | |
| 69979 | Not listed | Policies naming 69979 | |
| G0308 | Not listed | Policies naming G0308 | |
| G0309 | Not listed | Policies naming G0309 | |
| S2083 | Not listed | Policies naming S2083 |
All Anthem Blue Cross and Blue Shield New Hampshire policies · Anthem Blue Cross and Blue Shield New Hampshire prior authorization CPT list