Anthem Blue Cross Blue Shield of California policy
CG-MED-23 Home Health
CG-MED-23 Home Health is a public Anthem Blue Cross Blue Shield of California policy (policy CG-MED-23). It lists 128 CPT or HCPCS codes, 14 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
- CG-MED-23
- 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 |
|---|---|---|---|
| 99500 | Not listed | Policies naming 99500 | |
| 99503 | Not listed | Policies naming 99503 | |
| 99504 | Not listed | Policies naming 99504 | |
| 99505 | Not listed | Policies naming 99505 | |
| 99506 | Not listed | Policies naming 99506 | |
| 99507 | Not listed | Policies naming 99507 | |
| 99509 | Not listed | Policies naming 99509 | |
| 99511 | Not listed | Policies naming 99511 | |
| 99512 | Not listed | Policies naming 99512 | |
| 99600 | Not listed | Policies naming 99600 | |
| 99601 | Not listed | Policies naming 99601 | |
| 99602 | Not listed | Policies naming 99602 | |
| G0068 | Not listed | Policies naming G0068 | |
| G0069 | Not listed | Policies naming G0069 | |
| G0070 | Not listed | Policies naming G0070 | |
| G0088 | Not listed | Policies naming G0088 | |
| G0089 | Not listed | Policies naming G0089 | |
| G0090 | Not listed | Policies naming G0090 | |
| G0151 | Not listed | Policies naming G0151 | |
| G0152 | Not listed | Policies naming G0152 | |
| G0153 | Not listed | Policies naming G0153 | |
| G0155 | Not listed | Policies naming G0155 | |
| G0156 | Not listed | Policies naming G0156 | |
| G0157 | Not listed | Policies naming G0157 | |
| G0158 | Not listed | Policies naming G0158 | |
| G0159 | Not listed | Policies naming G0159 | |
| G0160 | Not listed | Policies naming G0160 | |
| G0161 | Not listed | Policies naming G0161 | |
| G0162 | Not listed | Policies naming G0162 | |
| G0299 | Not listed | Policies naming G0299 | |
| G0300 | Not listed | Policies naming G0300 | |
| G0320 | Not listed | Policies naming G0320 | |
| G0321 | Not listed | Policies naming G0321 | |
| G0322 | Not listed | Policies naming G0322 | |
| G0493 | Not listed | Policies naming G0493 | |
| G0494 | Not listed | Policies naming G0494 | |
| G0495 | Not listed | Policies naming G0495 | |
| G0496 | Not listed | Policies naming G0496 | |
| G2168 | Not listed | Policies naming G2168 | |
| G2169 | Not listed | Policies naming G2169 | |
| Q5001 | Not listed | Policies naming Q5001 | |
| Q5002 | Not listed | Policies naming Q5002 | |
| Q5009 | Not listed | Policies naming Q5009 | |
| S5035 | Not listed | Policies naming S5035 | |
| S5036 | Not listed | Policies naming S5036 | |
| S5108 | On the list | Home care training to home care client, per 15 minutes | Policies naming S5108 |
| S5109 | Not listed | Policies naming S5109 | |
| S5110 | On the list | Home care training, family; per 15 minutes | Policies naming S5110 |
| S5111 | Not listed | Policies naming S5111 | |
| S5115 | Not listed | Policies naming S5115 | |
| S5116 | Not listed | Policies naming S5116 | |
| S5180 | Not listed | Policies naming S5180 | |
| S5181 | Not listed | Policies naming S5181 | |
| S5497 | Not listed | Policies naming S5497 | |
| S5498 | Not listed | Policies naming S5498 | |
| S5501 | Not listed | Policies naming S5501 | |
| S5502 | Not listed | Policies naming S5502 | |
| S5517 | Not listed | Policies naming S5517 | |
| S5518 | Not listed | Policies naming S5518 | |
| S5520 | Not listed | Policies naming S5520 | |
| S5521 | Not listed | Policies naming S5521 | |
| S5522 | Not listed | Policies naming S5522 | |
| S5523 | Not listed | Policies naming S5523 | |
| S9061 | Not listed | Policies naming S9061 | |
| S9097 | Not listed | Policies naming S9097 | |
| S9122 | Not listed | Policies naming S9122 | |
| S9123 | On the list | Nursing care in the home ; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-99602 can be used) | Policies naming S9123 |
| S9124 | On the list | Nursing care in the home; by licensed practical nurse, per hour | Policies naming S9124 |
| S9127 | Not listed | Policies naming S9127 | |
| S9128 | Not listed | Policies naming S9128 | |
| S9129 | Not listed | Policies naming S9129 | |
| S9131 | Not listed | Policies naming S9131 | |
| S9209 | Not listed | Policies naming S9209 | |
| S9211 | Not listed | Policies naming S9211 | |
| S9212 | Not listed | Policies naming S9212 | |
| S9213 | Not listed | Policies naming S9213 | |
| S9214 | Not listed | Policies naming S9214 | |
| S9325 | Not listed | Policies naming S9325 | |
| S9326 | Not listed | Policies naming S9326 | |
| S9327 | Not listed | Policies naming S9327 | |
| S9328 | Not listed | Policies naming S9328 | |
| S9329 | Not listed | Policies naming S9329 | |
| S9330 | Not listed | Policies naming S9330 | |
| S9331 | Not listed | Policies naming S9331 | |
| S9336 | Not listed | Policies naming S9336 | |
| S9338 | Not listed | Policies naming S9338 | |
| S9345 | Not listed | Policies naming S9345 | |
| S9346 | Not listed | Policies naming S9346 | |
| S9348 | Not listed | Policies naming S9348 | |
| S9351 | Not listed | Policies naming S9351 | |
| S9353 | Not listed | Policies naming S9353 | |
| S9357 | Not listed | Policies naming S9357 | |
| S9361 | Not listed | Policies naming S9361 | |
| S9363 | Not listed | Policies naming S9363 | |
| S9364 | On the list | Home infusion therapy, total parenteral nutrition (TPN); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula, and nursing visits coded separately) per diem | Policies naming S9364 |
| S9365 | On the list | Home infusion therapy, total parenteral nutrition (TPN); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula, and nursing visits coded separately) per diem | Policies naming S9365 |
| S9366 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula, and nursing visits coded separately) per diem | Policies naming S9366 |
| S9367 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula, and nursing visits coded separately) per diem | Policies naming S9367 |
| S9368 | On the list | Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula, and nursing visits coded separately) per diem | Policies naming S9368 |
| S9370 | Not listed | Policies naming S9370 | |
| S9372 | Not listed | Policies naming S9372 | |
| S9373 | Not listed | Policies naming S9373 | |
| S9374 | Not listed | Policies naming S9374 | |
| S9375 | Not listed | Policies naming S9375 | |
| S9376 | Not listed | Policies naming S9376 | |
| S9377 | Not listed | Policies naming S9377 | |
| S9379 | Not listed | Policies naming S9379 | |
| S9490 | Not listed | Policies naming S9490 | |
| S9494 | Not listed | Policies naming S9494 | |
| S9497 | Not listed | Policies naming S9497 | |
| S9500 | Not listed | Policies naming S9500 | |
| S9501 | Not listed | Policies naming S9501 | |
| S9502 | Not listed | Policies naming S9502 | |
| S9503 | Not listed | Policies naming S9503 | |
| S9504 | Not listed | Policies naming S9504 | |
| S9538 | Not listed | Policies naming S9538 | |
| S9542 | Not listed | Policies naming S9542 | |
| S9560 | On the list | Home injectable therapy; hormonal therapy (e.g., leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | Policies naming S9560 |
| S9590 | Not listed | Policies naming S9590 | |
| S9810 | Not listed | Policies naming S9810 | |
| T1001 | Not listed | Policies naming T1001 | |
| T1002 | On the list | RN services, up to 15 minutes | Policies naming T1002 |
| T1003 | On the list | LPN/LVN services, up to 15 minutes | Policies naming T1003 |
| T1004 | Not listed | Policies naming T1004 | |
| T1021 | Not listed | Policies naming T1021 | |
| T1022 | Not listed | Policies naming T1022 | |
| T1030 | On the list | Nursing care, in the home, by registered nurse, per diem | Policies naming T1030 |
| T1031 | On the list | Nursing care, in the home, by licensed practical nurse, per diem | Policies naming T1031 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list