Anthem Blue Cross and Blue Shield Wisconsin policies, page 8

Search Anthem Blue Cross and Blue Shield Wisconsin's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

543 public policies Substrate tracks for Anthem Blue Cross and Blue Shield Wisconsin, by title.

Anthem Blue Cross and Blue Shield Wisconsin policies
PolicyDetailsCodesSource
MED.00101 Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s)MED.00101 · Commercial2Original policy ↗
MED.00102 Ultrafiltration in Decompensated Heart FailureMED.00102 · Commercial1Original policy ↗
MED.00110 Silver-based Products for Wound and Soft Tissue ApplicationsMED.00110 · Commercial1Original policy ↗
MED.00111 Intracardiac Ischemia MonitoringMED.00111 · Commercial9Original policy ↗
MED.00116 Near-Infrared Spectroscopy Scanning for Brain Hematoma ScreeningMED.00116 · Commercial1Original policy ↗
MED.00118 Continuous Monitoring of Intraocular PressureMED.00118 · Commercial1Original policy ↗
MED.00120 Gene Therapy for Ocular ConditionsMED.00120 · Commercial5Original policy ↗
MED.00129 Gene Therapy for Spinal Muscular AtrophyMED.00129 · Commercial2Original policy ↗
MED.00130 Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure MonitoringMED.00130 · Commercial3Original policy ↗
MED.00131 Electronic Home Visual Field Monitoring MED.00131 · Commercial2Original policy ↗
MED.00132 Autologous Adipose-derived Regenerative Cell TherapyMED.00132 · Commercial8Original policy ↗
MED.00133 Ingestion Event MonitorsMED.00133 · Commercial2Original policy ↗
MED.00135 Gene Therapy for HemophiliaMED.00135 · Commercial6Original policy ↗
MED.00137 Eye Movement Analysis Using Non-spatial Calibration for the Diagnosis of ConcussionMED.00137 · Commercial1Original policy ↗
MED.00138 Wearable Devices for Stress Relief and Management MED.00138 · Commercial2Original policy ↗
MED.00139 Electrical Impedance Scanning for Cancer DetectionMED.00139 · Commercial1Original policy ↗
MED.00140 Gene Therapy for Beta Thalassemia MED.00140 · Commercial5Original policy ↗
MED.00142 Gene Therapy for Cerebral AdrenoleukodystrophyMED.00142 · Commercial4Original policy ↗
MED.00143 Ingestible Devices for the Treatment of ConstipationMED.00143 · Commercial2Original policy ↗
MED.00146 Gene Therapy for Sickle Cell DiseaseMED.00146 · Commercial5Original policy ↗
MED.00148 Gene Therapy for Metachromatic LeukodystrophyMED.00148 · Commercial4Original policy ↗
MED.00150 Hepzato Kit™ (melphalan hepatic delivery system)MED.00150 · Commercial2Original policy ↗
MED.00151 Gene Therapy for Aromatic L-Amino Acid Decarboxylase DeficiencyMED.00151 · Commercial4Original policy ↗
MED.00152 Outpatient Intravenous Insulin TherapyMED.00152 · Commercial1Original policy ↗
Medical Record RequestsCommercial, Medicaid · WI—Original policy ↗
Medical Record Submission GuidelinesCommercial · WI—Original policy ↗
Medicare Advantage 2017 Precertification RequirementsEffective Jan 1, 2017 · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI132Original policy ↗
Medicare Advantage 2018 Precertification RequirementsEffective Jan 1, 2018 · CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI158Original policy ↗
Medicare Advantage Precertification Requirements – 2019CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, VA, WI191Original policy ↗
Medicare Advantage Provider ManualMULTI-BCBS-CR-PM-008700-26-GRP2620 · Effective Apr 1, 2026 · CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, WI—Original policy ↗
Medicare Supplement System Consolidation FAQs59396MUPENMUB · Commercial · IN, KY, MO, OH, WI—Original policy ↗
Member Identification, Eligibility and BenefitsCommercial, Medicaid · WI—Original policy ↗
Moderate (Conscious) Sedation – Professional and FacilityC-25001 · Effective Oct 1, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI6Original policy ↗
Modifier 22 – ProfessionalC-12003 · Effective May 6, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifier 62 – ProfessionalC-21005 · Effective Nov 17, 2023 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI—Original policy ↗
Modifier 66 – ProfessionalC-21006 · Effective Nov 17, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifier FB – Professional and FacilityC-22003 · Effective Oct 1, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifier Usage - FacilityC-23005 · Effective Apr 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifier Usage – ProfessionalC-08010 · Effective Jun 3, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI12Original policy ↗
Modifiers 25 and 57: Evaluation and Management with Global ProceduresC-09011 · Effective Nov 23, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI8Original policy ↗
Modifiers 26 and TC: Professional and Technical Component - ProfessionalC-20004 · Effective Dec 2, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Modifiers 50 and 51: Multiple and Bilateral Surgery - ProfessionalC-08004 · Effective Oct 30, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI63Original policy ↗
Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service - ProfessionalC-09006 · Effective Mar 15, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI187Original policy ↗
Modifiers 80, 81, 82 and AS: Assistant at Surgery - ProfessionalC-08006 · Effective Sep 27, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI44Original policy ↗
Modifiers 90, 91, and 92: Laboratory Services – Professional and FacilityC-26002 · Effective Nov 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI6Original policy ↗
Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor TherapyLAB.00042 · Commercial1Original policy ↗
MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic IndicationsMED.00057 · Commercial6Original policy ↗
Multiple Delivery Services – ProfessionalC-19005 · Effective Apr 29, 2022 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Multiple Diagnostic Imaging Procedures – Professional and FacilityC-25003 · Effective Oct 26, 2025 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI—Original policy ↗
Multiple Procedure Payment Reduction – ProfessionalC-23003 · Effective Apr 12, 2023 · Commercial · CO, CT, GA, IN, KY, MO, NH, NV, OH, WI—Original policy ↗

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Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.