Anthem Blue Cross Blue Shield of California policy
CG-MED-65 Manipulation Under Anesthesia
CG-MED-65 Manipulation Under Anesthesia is a public Anthem Blue Cross Blue Shield of California policy (policy CG-MED-65). It lists 6 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
- CG-MED-65
- 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 |
|---|---|---|---|
| 22505 | On the list | Manipulation of the spine requiring anesthesia, any region | Policies naming 22505 |
| 24300 | On the list | Manipulation, elbow, under anesthesia | Policies naming 24300 |
| 25259 | On the list | Manipulation, wrist, under anesthesia | Policies naming 25259 |
| 26340 | On the list | Manipulation, finger joint, under anesthesia, each joint | Policies naming 26340 |
| 27275 | On the list | Manipulation, hip joint, requiring general anesthesia | Policies naming 27275 |
| 27860 | On the list | Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) | Policies naming 27860 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list