Anthem Blue Cross and Blue Shield Virginia policy
CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting
CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-DME-46). It lists 18 CPT or HCPCS codes, 17 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-DME-46
- 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 Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| A4600 | On the list | SLEEVE FOR INTERMITTENT LIMB COMPRESSION DEVICE, REPLACEMENT ONLY, EACH | Policies naming A4600 |
| E0650 | On the list | Pneuma Compresor Non-Segment | Policies naming E0650 |
| E0651 | On the list | Pneum Compressor Segmental | Policies naming E0651 |
| E0652 | On the list | Pneum Compres W/Cal Pressure | Policies naming E0652 |
| E0655 | On the list | Pneumatic Appliance Half Arm | Policies naming E0655 |
| E0658 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest | Policies naming E0658 |
| E0660 | On the list | Pneumatic Appliance Full Leg | Policies naming E0660 |
| E0665 | On the list | Pneumatic Appliance Full Arm | Policies naming E0665 |
| E0666 | On the list | Pneumatic Appliance Half Leg | Policies naming E0666 |
| E0667 | On the list | Seg Pneumatic Appl Full Leg | Policies naming E0667 |
| E0668 | On the list | Seg Pneumatic Appl Full Arm | Policies naming E0668 |
| E0669 | On the list | Seg Pneumatic Appli Half Leg | Policies naming E0669 |
| E0670 | On the list | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk | Policies naming E0670 |
| E0671 | On the list | Pressure Pneum Appl Full Leg | Policies naming E0671 |
| E0672 | On the list | Pressure Pneum Appl Full Arm | Policies naming E0672 |
| E0673 | On the list | Pressure Pneum Appl Half Leg | Policies naming E0673 |
| E0675 | Not listed | Policies naming E0675 | |
| E0676 | On the list | INTERMITTENT LIMB COMPRESSION DEVICE (INCLUDES ALL ACCESSORIES), NOT OTHERWISE | Policies naming E0676 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list