Anthem Blue Cross and Blue Shield Virginia policy
SURG.00145 Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)
SURG.00145 Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) is a public Anthem Blue Cross and Blue Shield Virginia policy (policy SURG.00145). It lists 12 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
- SURG.00145
- 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 |
|---|---|---|---|
| 33927 | On the list | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy | Policies naming 33927 |
| 33928 | On the list | Removal and replacement of total replacement heart system (artificial heart) | Policies naming 33928 |
| 33975 | On the list | Insertion, Ventricular Assist Device; Extracorporeal, Single Ventricle | Policies naming 33975 |
| 33976 | On the list | Insertion, Ventricular Assist Device; Extracorporeal, Biventricular | Policies naming 33976 |
| 33979 | On the list | Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle | Policies naming 33979 |
| 33981 | On the list | Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump | Policies naming 33981 |
| 33982 | On the list | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary | Policies naming 33982 |
| 33983 | On the list | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary byp | Policies naming 33983 |
| 33990 | On the list | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, arterial access only | Policies naming 33990 |
| 33991 | On the list | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; left heart, both arterial and venous access, with transseptal punc | Policies naming 33991 |
| 33993 | On the list | Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at separate and distinct session from insertion | Policies naming 33993 |
| 33995 | On the list | Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only | Policies naming 33995 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list