Anthem Blue Cross and Blue Shield Virginia policy
DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices is a public Anthem Blue Cross and Blue Shield Virginia policy (policy DME.00038). It lists 9 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.
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- Policy number
- DME.00038
- 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 |
|---|---|---|---|
| E1801 | On the list | Static progressive stretch/patient actualized serial stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and ac | Policies naming E1801 |
| E1806 | On the list | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes | Policies naming E1806 |
| E1811 | On the list | Static progressive stretch/patient actualized serial stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and acc | Policies naming E1811 |
| E1816 | On the list | Static progressive stretch/patient actualized serial stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and ac | Policies naming E1816 |
| E1818 | Not listed | Policies naming E1818 | |
| E1821 | Not listed | Policies naming E1821 | |
| E1831 | Not listed | Policies naming E1831 | |
| E1832 | Not listed | Policies naming E1832 | |
| E1841 | On the list | Static progressive stretch/patient actualized serial stretch shoulder device, with or without range of motion adjustment, includes all components and accessories | Policies naming E1841 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list