Anthem Blue Cross Blue Shield of California policy
Anesthesia Services - Professional
Anesthesia Services - Professional is a public Anthem Blue Cross Blue Shield of California policy (policy C-09002, effective Apr 1, 2026). It lists 33 CPT or HCPCS codes, 6 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
- C-09002
- Effective
- Apr 1, 2026
- Line of business
- Commercial
- 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.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of California policies |
|---|---|---|---|
| 00170 | On the list | Anesthesia for intraoral procedures, including biopsy; not otherwise specified | Policies naming 00170 |
| 00176 | Not listed | Policies naming 00176 | |
| 01953 | Not listed | Policies naming 01953 | |
| 01968 | Not listed | Policies naming 01968 | |
| 01969 | Not listed | Policies naming 01969 | |
| 01996 | Not listed | Policies naming 01996 | |
| 31500 | Not listed | Policies naming 31500 | |
| 43200 | Not listed | Policies naming 43200 | |
| 43753 | Not listed | Policies naming 43753 | |
| 43754 | Not listed | Policies naming 43754 | |
| 60000 | Not listed | Policies naming 60000 | |
| 62320 | On the list | Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic | Policies naming 62320 |
| 62327 | Not listed | Policies naming 62327 | |
| 64400 | Not listed | Policies naming 64400 | |
| 64412 | Not listed | Policies naming 64412 | |
| 64450 | On the list | Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch | Policies naming 64450 |
| 91000 | Not listed | Policies naming 91000 | |
| 91055 | Not listed | Policies naming 91055 | |
| 91105 | Not listed | Policies naming 91105 | |
| 93015 | Not listed | Policies naming 93015 | |
| 93018 | Not listed | Policies naming 93018 | |
| 93312 | On the list | Echocardiography, transesophageal, real-time with image documentation (2-D) (with or without M-mode recording) | Policies naming 93312 |
| 93317 | On the list | Echocardiography, transesophageal, image acquisition, interpretation and report only (congenital cardiac anomalies) | Policies naming 93317 |
| 93318 | Not listed | Policies naming 93318 | |
| 93355 | Not listed | Policies naming 93355 | |
| 94150 | Not listed | Policies naming 94150 | |
| 99100 | Not listed | Policies naming 99100 | |
| 99116 | Not listed | Policies naming 99116 | |
| 99135 | Not listed | Policies naming 99135 | |
| 99140 | Not listed | Policies naming 99140 | |
| D9211 | Not listed | Policies naming D9211 | |
| D9248 | Not listed | Policies naming D9248 | |
| J3490 | On the list | Unclassified drugs or biologicals [when specified as eladocagene exuparvovec-tneq (Kebilidi)] or [when specified as an ocular gene therapy agent other than voretigene neparvovec-rzyl (Luxturna)] or [when specified as elivaldogene autotemcel (Skysona)] or [when specified as etuvetidigene autotemcel (Waskyra)] or [when specified as a gene therapy for hemophilia other than Hemgenix, Beqvez, or Roctavian] | Policies naming J3490 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list