Anthem Blue Cross and Blue Shield Virginia policy
CG-SURG-79 Implantable Infusion Pumps
CG-SURG-79 Implantable Infusion Pumps is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-SURG-79). It lists 18 CPT or HCPCS codes, 12 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- CG-SURG-79
- 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 |
|---|---|---|---|
| 36260 | On the list | Insertion, Implantable Intra-Arterial Infusion Pump | Policies naming 36260 |
| 36261 | On the list | Revision, Implanted Intra-Arterial Infusion Pump | Policies naming 36261 |
| 36262 | Not listed | Policies naming 36262 | |
| 36563 | On the list | Insertion of Tunneled Centrally Inserted Central Venous Access Device with Subcutaneous Pump | Policies naming 36563 |
| 36583 | On the list | Replacement, Complete, of a Tunneled Centrally Inserted Central Venous Access Device, w Sq Pump, Via Same Access | Policies naming 36583 |
| 61215 | On the list | Insertion, Subq Reservoir/Pump/Infusion System, Ventricular Catheter | Policies naming 61215 |
| 62350 | Not listed | Policies naming 62350 | |
| 62351 | Not listed | Policies naming 62351 | |
| 62360 | Not listed | Policies naming 62360 | |
| 62361 | On the list | Implantation/Replace, Device, Intrathecal/Epidural Drug Infusion; Non-Programmable Pump | Policies naming 62361 |
| 62362 | On the list | Implantation/Replace, Device, Intrathecal/Epidural Drug Infusion; Programmable Pump | Policies naming 62362 |
| 62365 | Not listed | Policies naming 62365 | |
| C1772 | On the list | Infusion pump, programmable (implantable) | Policies naming C1772 |
| C1891 | Not listed | Policies naming C1891 | |
| C2626 | On the list | Infusion pump, nonprogrammable, temporary (implantable) | Policies naming C2626 |
| E0782 | On the list | Non-Programble Infusion Pump | Policies naming E0782 |
| E0783 | On the list | Programmable Infusion Pump | Policies naming E0783 |
| E0786 | On the list | Implantable Pump Replacement | Policies naming E0786 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list