Anthem Blue Cross Blue Shield of California policy
LAB.00045 Selected Tests for the Evaluation and Management of Infertility
LAB.00045 Selected Tests for the Evaluation and Management of Infertility is a public Anthem Blue Cross Blue Shield of California policy (policy LAB.00045). It lists 5 CPT or HCPCS codes, 5 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
- LAB.00045
- 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 |
|---|---|---|---|
| 0255U | On the list | Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score | Policies naming 0255U |
| 86357 | On the list | Natural killer (NK) cells, total count | Policies naming 86357 |
| 89329 | On the list | Sperm evaluation; hamster penetration test | Policies naming 89329 |
| 89330 | On the list | Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test | Policies naming 89330 |
| 89398 | On the list | Unlisted reproductive medicine laboratory procedure [when specified as a sperm DNA fragmentation test] | Policies naming 89398 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list