Anthem Blue Cross and Blue Shield Virginia policy
Anesthesia Services – Professional
Anesthesia Services – Professional is a public Anthem Blue Cross and Blue Shield Virginia policy (policy C-09002, effective Mar 1, 2025). It lists 21 CPT or HCPCS codes, 5 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Policy number
- C-09002
- Effective
- Mar 1, 2025
- Line of business
- Commercial
- States
- VA
- 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 Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| 00170 | On the list | Anesthesia, Intraoral Proc, W/Bx; Nos | Policies naming 00170 |
| 00176 | Not listed | Policies naming 00176 | |
| 01953 | Not listed | Policies naming 01953 | |
| 01968 | Not listed | Policies naming 01968 | |
| 01969 | Not listed | Policies naming 01969 | |
| 01996 | Not listed | Policies naming 01996 | |
| 62320 | On the list | Injection(s) of diagnostic or therapeutic substance(s) (eg. anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle | Policies naming 62320 |
| 62327 | Not listed | Policies naming 62327 | |
| 64400 | Not listed | Policies naming 64400 | |
| 64412 | Not listed | Policies naming 64412 | |
| 64450 | On the list | Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch | Policies naming 64450 |
| 93312 | On the list | Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including | Policies naming 93312 |
| 93317 | On the list | Echocardiography, Transesophageal, Congenital Anomalies; Image, Interpretation & Report | Policies naming 93317 |
| 93318 | Not listed | Policies naming 93318 | |
| 93355 | Not listed | Policies naming 93355 | |
| 99100 | Not listed | Policies naming 99100 | |
| 99116 | Not listed | Policies naming 99116 | |
| 99135 | Not listed | Policies naming 99135 | |
| 99140 | Not listed | Policies naming 99140 | |
| D9211 | Not listed | Policies naming D9211 | |
| D9248 | Not listed | Policies naming D9248 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list