Anthem Blue Cross Blue Shield of California policy

HEDIS measurement year 2023–2024

HEDIS measurement year 2023–2024 is a public Anthem Blue Cross Blue Shield of California policy. It lists 451 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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Payer
Anthem Blue Cross Blue Shield of California
Line of business
Commercial, Medicaid
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.

CodePrior authorizationDescription on the prior authorization listOther Anthem Blue Cross Blue Shield of California policies
0500FNot listedPolicies naming 0500F
0501FNot listedPolicies naming 0501F
0502FNot listedPolicies naming 0502F
0503FNot listedPolicies naming 0503F
1111FNot listedPolicies naming 1111F
1125FNot listedPolicies naming 1125F
1126FNot listedPolicies naming 1126F
1159FNot listedPolicies naming 1159F
1160FNot listedPolicies naming 1160F
1170FNot listedPolicies naming 1170F
19300On the listMastectomy for gynecomastiaPolicies naming 19300
19307Not listedPolicies naming 19307
2022FNot listedPolicies naming 2022F
2023FNot listedPolicies naming 2023F
2024FNot listedPolicies naming 2024F
2025FNot listedPolicies naming 2025F
2026FNot listedPolicies naming 2026F
2033FNot listedPolicies naming 2033F
3044FNot listedPolicies naming 3044F
3046FNot listedPolicies naming 3046F
3051FNot listedPolicies naming 3051F
3052FNot listedPolicies naming 3052F
3072FNot listedPolicies naming 3072F
3074FNot listedPolicies naming 3074F
3075FNot listedPolicies naming 3075F
3077FNot listedPolicies naming 3077F
3078FNot listedPolicies naming 3078F
3079FNot listedPolicies naming 3079F
3080FNot listedPolicies naming 3080F
44388Not listedPolicies naming 44388
44389Not listedPolicies naming 44389
44390Not listedPolicies naming 44390
44392Not listedPolicies naming 44392
44401Not listedPolicies naming 44401
44408Not listedPolicies naming 44408
45330Not listedPolicies naming 45330
45335Not listedPolicies naming 45335
45337Not listedPolicies naming 45337
45338Not listedPolicies naming 45338
45346Not listedPolicies naming 45346
45347Not listedPolicies naming 45347
45349Not listedPolicies naming 45349
45350Not listedPolicies naming 45350
45352Not listedPolicies naming 45352
45378On the listColonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)Policies naming 45378
45379Not listedPolicies naming 45379
45380On the listColonoscopy, flexible; with biopsy, single or multiplePolicies naming 45380
45382Not listedPolicies naming 45382
45384On the listColonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forcepsPolicies naming 45384
45386Not listedPolicies naming 45386
45388On the listColonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)Policies naming 45388
45389Not listedPolicies naming 45389
45390Not listedPolicies naming 45390
45393Not listedPolicies naming 45393
45398Not listedPolicies naming 45398
57170Not listedPolicies naming 57170
58300Not listedPolicies naming 58300
59400Not listedPolicies naming 59400
59409Not listedPolicies naming 59409
59410Not listedPolicies naming 59410
59425Not listedPolicies naming 59425
59426Not listedPolicies naming 59426
59430Not listedPolicies naming 59430
59510Not listedPolicies naming 59510
59514Not listedPolicies naming 59514
59515Not listedPolicies naming 59515
59610Not listedPolicies naming 59610
59612Not listedPolicies naming 59612
59614Not listedPolicies naming 59614
59618Not listedPolicies naming 59618
59620Not listedPolicies naming 59620
59622Not listedPolicies naming 59622
65091Not listedPolicies naming 65091
65093Not listedPolicies naming 65093
65101Not listedPolicies naming 65101
65103Not listedPolicies naming 65103
65105Not listedPolicies naming 65105
65110Not listedPolicies naming 65110
65112Not listedPolicies naming 65112
65114Not listedPolicies naming 65114
67028Not listedPolicies naming 67028
67030Not listedPolicies naming 67030
67031Not listedPolicies naming 67031
67036Not listedPolicies naming 67036
67039Not listedPolicies naming 67039
67040Not listedPolicies naming 67040
67041Not listedPolicies naming 67041
67042Not listedPolicies naming 67042
67043Not listedPolicies naming 67043
67101Not listedPolicies naming 67101
67105Not listedPolicies naming 67105
67107Not listedPolicies naming 67107
67108Not listedPolicies naming 67108
67110Not listedPolicies naming 67110
67113Not listedPolicies naming 67113
67121Not listedPolicies naming 67121
67141Not listedPolicies naming 67141
67145Not listedPolicies naming 67145
67208Not listedPolicies naming 67208
67210Not listedPolicies naming 67210
67218On the listDestruction of localized lesion of retina (e.g., macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source)Policies naming 67218
67220Not listedPolicies naming 67220
67221Not listedPolicies naming 67221
67227Not listedPolicies naming 67227
67228Not listedPolicies naming 67228
74261On the listComputed tomographic (CT) colonography, diagnostic, including image post processing; without contrast materialPolicies naming 74261
74263On the listComputed tomographic (CT) colonography, screening, including image post processingPolicies naming 74263
77061Not listedPolicies naming 77061
77063Not listedPolicies naming 77063
77065Not listedPolicies naming 77065
77067Not listedPolicies naming 77067
80047Not listedPolicies naming 80047
80048Not listedPolicies naming 80048
80050Not listedPolicies naming 80050
80053Not listedPolicies naming 80053
80069Not listedPolicies naming 80069
81528Not listedPolicies naming 81528
82270Not listedPolicies naming 82270
82274Not listedPolicies naming 82274
82947Not listedPolicies naming 82947
82950Not listedPolicies naming 82950
82951Not listedPolicies naming 82951
83036Not listedPolicies naming 83036
83037Not listedPolicies naming 83037
87624Not listedPolicies naming 87624
87625Not listedPolicies naming 87625
88141Not listedPolicies naming 88141
88143Not listedPolicies naming 88143
88147Not listedPolicies naming 88147
88148Not listedPolicies naming 88148
88150Not listedPolicies naming 88150
88152Not listedPolicies naming 88152
88154Not listedPolicies naming 88154
88164Not listedPolicies naming 88164
88167Not listedPolicies naming 88167
88174Not listedPolicies naming 88174
88175Not listedPolicies naming 88175
90619Not listedPolicies naming 90619
90633Not listedPolicies naming 90633
90644Not listedPolicies naming 90644
90647Not listedPolicies naming 90647
90648Not listedPolicies naming 90648
90649Not listedPolicies naming 90649
90650Not listedPolicies naming 90650
90651Not listedPolicies naming 90651
90655Not listedPolicies naming 90655
90657Not listedPolicies naming 90657
90661Not listedPolicies naming 90661
90670Not listedPolicies naming 90670
90673Not listedPolicies naming 90673
90680Not listedPolicies naming 90680
90681Not listedPolicies naming 90681
90685Not listedPolicies naming 90685
90686Not listedPolicies naming 90686
90687Not listedPolicies naming 90687
90688Not listedPolicies naming 90688
90689Not listedPolicies naming 90689
90697Not listedPolicies naming 90697
90698Not listedPolicies naming 90698
90700Not listedPolicies naming 90700
90707Not listedPolicies naming 90707
90710Not listedPolicies naming 90710
90713Not listedPolicies naming 90713
90715Not listedPolicies naming 90715
90716Not listedPolicies naming 90716
90723Not listedPolicies naming 90723
90733Not listedPolicies naming 90733
90734Not listedPolicies naming 90734
90740Not listedPolicies naming 90740
90744Not listedPolicies naming 90744
90747Not listedPolicies naming 90747
90748Not listedPolicies naming 90748
90791Not listedPolicies naming 90791
90792Not listedPolicies naming 90792
90832Not listedPolicies naming 90832
90834Not listedPolicies naming 90834
90836Not listedPolicies naming 90836
90840Not listedPolicies naming 90840
90847Not listedPolicies naming 90847
90853Not listedPolicies naming 90853
90863Not listedPolicies naming 90863
90870Not listedPolicies naming 90870
90875On the listIndividual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (e.g., insight oriented, behavior modifying or supportive psychotherapy); 30 minutes or [when specified as EEG biofeedback or neurofeedback]Policies naming 90875
90876On the listIndividual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (e.g., insight oriented, behavior modifying or supportive psychotherapy); 45 minutes or [when specified as EEG biofeedback or neurofeedback]Policies naming 90876
92002Not listedPolicies naming 92002
92004Not listedPolicies naming 92004
92012Not listedPolicies naming 92012
92014Not listedPolicies naming 92014
92018Not listedPolicies naming 92018
92019Not listedPolicies naming 92019
92134Not listedPolicies naming 92134
92201Not listedPolicies naming 92201
92202Not listedPolicies naming 92202
92230Not listedPolicies naming 92230
92235Not listedPolicies naming 92235
92240Not listedPolicies naming 92240
92250Not listedPolicies naming 92250
92260Not listedPolicies naming 92260
97802Not listedPolicies naming 97802
97804Not listedPolicies naming 97804
98960Not listedPolicies naming 98960
98962Not listedPolicies naming 98962
98966Not listedPolicies naming 98966
98968Not listedPolicies naming 98968
98969Not listedPolicies naming 98969
98970Not listedPolicies naming 98970
98972Not listedPolicies naming 98972
99078Not listedPolicies naming 99078
99202Not listedPolicies naming 99202
99203Not listedPolicies naming 99203
99204Not listedPolicies naming 99204
99205Not listedPolicies naming 99205
99211Not listedPolicies naming 99211
99213Not listedPolicies naming 99213
99214Not listedPolicies naming 99214
99215Not listedPolicies naming 99215
99217Not listedPolicies naming 99217
99220Not listedPolicies naming 99220
99221Not listedPolicies naming 99221
99223Not listedPolicies naming 99223
99227Not listedPolicies naming 99227
99228Not listedPolicies naming 99228
99231Not listedPolicies naming 99231
99233Not listedPolicies naming 99233
99238Not listedPolicies naming 99238
99239Not listedPolicies naming 99239
99241Not listedPolicies naming 99241
99242Not listedPolicies naming 99242
99243Not listedPolicies naming 99243
99244Not listedPolicies naming 99244
99245Not listedPolicies naming 99245
99251Not listedPolicies naming 99251
99252Not listedPolicies naming 99252
99255Not listedPolicies naming 99255
99281Not listedPolicies naming 99281
99285Not listedPolicies naming 99285
99291Not listedPolicies naming 99291
99304Not listedPolicies naming 99304
99310Not listedPolicies naming 99310
99315Not listedPolicies naming 99315
99316Not listedPolicies naming 99316
99318Not listedPolicies naming 99318
99341Not listedPolicies naming 99341
99345Not listedPolicies naming 99345
99347Not listedPolicies naming 99347
99349Not listedPolicies naming 99349
99350Not listedPolicies naming 99350
99377Not listedPolicies naming 99377
99378Not listedPolicies naming 99378
99381Not listedPolicies naming 99381
99385Not listedPolicies naming 99385
99387Not listedPolicies naming 99387
99391Not listedPolicies naming 99391
99395Not listedPolicies naming 99395
99397Not listedPolicies naming 99397
99401Not listedPolicies naming 99401
99403Not listedPolicies naming 99403
99404Not listedPolicies naming 99404
99411Not listedPolicies naming 99411
99412Not listedPolicies naming 99412
99421Not listedPolicies naming 99421
99423Not listedPolicies naming 99423
99429Not listedPolicies naming 99429
99441Not listedPolicies naming 99441
99443Not listedPolicies naming 99443
99455Not listedPolicies naming 99455
99456Not listedPolicies naming 99456
99457Not listedPolicies naming 99457
99461Not listedPolicies naming 99461
99483Not listedPolicies naming 99483
99492Not listedPolicies naming 99492
99494Not listedPolicies naming 99494
99495Not listedPolicies naming 99495
99496Not listedPolicies naming 99496
99500Not listedPolicies naming 99500
99501Not listedPolicies naming 99501
99504Not listedPolicies naming 99504
99509Not listedPolicies naming 99509
99510Not listedPolicies naming 99510
99605Not listedPolicies naming 99605
99606Not listedPolicies naming 99606
99968Not listedPolicies naming 99968
E0100Not listedPolicies naming E0100
E0105Not listedPolicies naming E0105
E0130Not listedPolicies naming E0130
E0135Not listedPolicies naming E0135
E0140Not listedPolicies naming E0140
E0141Not listedPolicies naming E0141
E0144Not listedPolicies naming E0144
E0147Not listedPolicies naming E0147
E0149Not listedPolicies naming E0149
E0163Not listedPolicies naming E0163
E0165Not listedPolicies naming E0165
E0167Not listedPolicies naming E0167
E0168Not listedPolicies naming E0168
E0170Not listedPolicies naming E0170
E0171Not listedPolicies naming E0171
E0250Not listedPolicies naming E0250
E0251Not listedPolicies naming E0251
E0255Not listedPolicies naming E0255

And 151 more in the original policy.

All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.