Anthem Blue Cross and Blue Shield Virginia policy
CG-SURG-35 Intracytoplasmic Sperm Injection (ICSI)
CG-SURG-35 Intracytoplasmic Sperm Injection (ICSI) is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-SURG-35). It lists 2 CPT or HCPCS codes, 2 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-SURG-35
- 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 |
|---|---|---|---|
| 89280 | On the list | Assisted Oocyte Fertilization, Microtechnique; Less Than or Equal To 10 Oocytes | Policies naming 89280 |
| 89281 | On the list | Assisted Oocyte Fertilization, Microtechnique; Greater Than 10 Oocytes | Policies naming 89281 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list