Anthem Blue Cross Blue Shield of California policy
ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities
ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities is a public Anthem Blue Cross Blue Shield of California policy (policy ANC.00009). It lists 23 CPT or HCPCS codes, 23 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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- Policy number
- ANC.00009
- 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 Blue Shield of California prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of California policies |
|---|---|---|---|
| 15832 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh | Policies naming 15832 |
| 15833 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg | Policies naming 15833 |
| 15834 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip | Policies naming 15834 |
| 15835 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock | Policies naming 15835 |
| 15836 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm | Policies naming 15836 |
| 15837 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand | Policies naming 15837 |
| 15839 | On the list | Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area | Policies naming 15839 |
| 15877 | On the list | Suction assisted lipectomy; trunk | Policies naming 15877 |
| 15878 | On the list | Suction assisted lipectomy; upper extremity | Policies naming 15878 |
| 15879 | On the list | Suction assisted lipectomy; lower extremity | Policies naming 15879 |
| 21740 | On the list | Reconstructive repair of pectus excavatum or carinatum; open | Policies naming 21740 |
| 21742 | On the list | Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy | Policies naming 21742 |
| 21743 | On the list | Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy | Policies naming 21743 |
| 54360 | On the list | Plastic operation on penis to correct angulation | Policies naming 54360 |
| 54440 | On the list | Plastic operation of penis for injury | Policies naming 54440 |
| 55899 | On the list | Unlisted procedure, male genital system [when specified as phalloplasty] or [when specified as image-guided focused ultrasound ablation of prostate tissue for non-oncologic indications, such as benign prostatic hyperplasia] or [when specified as intracavernous injection of autologous adipose- derived regenerative cells, e.g., for erectile dysfunction] or [when specified as nanoparticle thermal ablation] or [when specified as histotripsy of prostate tissue] | Policies naming 55899 |
| 56800 | On the list | Plastic repair of introitus | Policies naming 56800 |
| 56805 | On the list | Clitoroplasty for intersex state | Policies naming 56805 |
| 56810 | On the list | Perineoplasty, repair of perineum, nonobstetrical (separate procedure) | Policies naming 56810 |
| 57291 | On the list | Construction of artificial vagina; without graft | Policies naming 57291 |
| 57292 | On the list | Construction of artificial vagina; with graft | Policies naming 57292 |
| 57335 | On the list | Vaginoplasty for intersex state | Policies naming 57335 |
| 58999 | On the list | Unlisted procedure, female genital system (nonobstetrical) [when specified as any vaginal rejuvenation or tightening procedure for atrophy, including laser procedures such as MonaLisa Touch] or [when specified as cancer screening or identification using an optical detection system] or [when specified as image-guided percutaneous ablation by laser, bipolar electrodes, interstitial thermotherapy, cryotherapy, radiofrequency] | Policies naming 58999 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list