Anthem Blue Cross Blue Shield of California policy
DME.00022 Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)
DME.00022 Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES) is a public Anthem Blue Cross Blue Shield of California policy (policy DME.00022). It lists 5 CPT or HCPCS codes, 4 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
- DME.00022
- 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 |
|---|---|---|---|
| 00022 | Not listed | Policies naming 00022 | |
| E0745 | On the list | Neuromuscular stimulator, electronic shock unit | Policies naming E0745 |
| E0764 | On the list | Functional neuromuscular stimulation, transcutaneous stimulation of sequential muscle groups of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program | Policies naming E0764 |
| E0770 | On the list | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified | Policies naming E0770 |
| E1399 | On the list | Durable medical equipment, miscellaneous | Policies naming E1399 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list