Anthem Blue Cross Blue Shield of California policy

2025 Anthem Blue Cross PPO Provider Manual v2

2025 Anthem Blue Cross PPO Provider Manual v2 is a public Anthem Blue Cross Blue Shield of California policy (policy CABC-CM-PM-091236-25, effective Jun 1, 2026). It lists 47 CPT or HCPCS codes, 2 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.

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Payer
Anthem Blue Cross Blue Shield of California
Policy number
CABC-CM-PM-091236-25
Effective
Jun 1, 2026
Line of business
Commercial, Medicaid
States
CA
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 Blue Shield of California prior authorization list.

CodePrior authorizationDescription on the prior authorization listOther Anthem Blue Cross Blue Shield of California policies
00001Not listedPolicies naming 00001
00004Not listedPolicies naming 00004
00005Not listedPolicies naming 00005
10133Not listedPolicies naming 10133
12345Not listedPolicies naming 12345
17785Not listedPolicies naming 17785
21215On the listGraft, bone; mandible (includes obtaining graft)Policies naming 21215
30308Not listedPolicies naming 30308
30348Not listedPolicies naming 30348
36415Not listedPolicies naming 36415
36416Not listedPolicies naming 36416
44135On the listIntestinal allotransplantation; from cadaver donorPolicies naming 44135
44193Not listedPolicies naming 44193
45040Not listedPolicies naming 45040
59400Not listedPolicies naming 59400
59410Not listedPolicies naming 59410
59510Not listedPolicies naming 59510
59515Not listedPolicies naming 59515
59610Not listedPolicies naming 59610
59612Not listedPolicies naming 59612
59614Not listedPolicies naming 59614
59618Not listedPolicies naming 59618
59620Not listedPolicies naming 59620
59622Not listedPolicies naming 59622
60007Not listedPolicies naming 60007
70022Not listedPolicies naming 70022
73651Not listedPolicies naming 73651
80217Not listedPolicies naming 80217
90013Not listedPolicies naming 90013
90060Not listedPolicies naming 90060
91365Not listedPolicies naming 91365
91367Not listedPolicies naming 91367
92825Not listedPolicies naming 92825
94760Not listedPolicies naming 94760
94761Not listedPolicies naming 94761
94762Not listedPolicies naming 94762
95817Not listedPolicies naming 95817
95927Not listedPolicies naming 95927
96365Not listedPolicies naming 96365
96366Not listedPolicies naming 96366
96368Not listedPolicies naming 96368
96374Not listedPolicies naming 96374
96379Not listedPolicies naming 96379
99001Not listedPolicies naming 99001
G0001Not listedPolicies naming G0001
J0610Not listedPolicies naming J0610
S2900Not listedPolicies naming S2900

All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list

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.