Anthem Blue Cross Blue Shield of California policy
MED.00004 Noninvasive Imaging Technologies for the Evaluation of Skin Lesions
MED.00004 Noninvasive Imaging Technologies for the Evaluation of Skin Lesions is a public Anthem Blue Cross Blue Shield of California policy (policy MED.00004). It lists 12 CPT or HCPCS codes, 12 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
- MED.00004
- 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 |
|---|---|---|---|
| 0658T | On the list | Electrical impedance spectroscopy of 1 or more skin lesions for automated melanoma risk score | Policies naming 0658T |
| 0700T | On the list | Molecular fluorescent imaging of suspicious nevus; first lesion | Policies naming 0700T |
| 0701T | On the list | Molecular fluorescent imaging of suspicious nevus; each additional lesion | Policies naming 0701T |
| 1020T | On the list | Raman spectroscopy of 1 or more skin lesions, with probability score for malignant risk derived by algorithmic analysis of data from each lesion | Policies naming 1020T |
| 96904 | On the list | Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma | Policies naming 96904 |
| 96931 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; image acquisition and interpretation and report, first lesion | Policies naming 96931 |
| 96932 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; image acquisition only, first lesion | Policies naming 96932 |
| 96933 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; interpretation and report only, first lesion | Policies naming 96933 |
| 96934 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; image acquisition and interpretation and report, each additional lesion | Policies naming 96934 |
| 96935 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; image acquisition only, each additional lesion | Policies naming 96935 |
| 96936 | On the list | Reflectance confocal microscopy (RCM) for cellular and sub- cellular imaging of skin; interpretation and report only, each additional lesion | Policies naming 96936 |
| 96999 | On the list | Unlisted special dermatological service or procedure[when specified as dermatoscopy techniques such as dermoscopy, epiluminescence microscopy, or digital epiluminescence microscopy, skin surface microscopy, skin videomicroscopy, incidence light microscopy or reflectance confocal microscopy not generating mosaic images] or [when specified as ultrasonography of the skin for skin lesions] or [when specified as tunable dye or pulsed dye laser treatment for varicose veins] or [when specified as laser treatment of onychomycosis] | Policies naming 96999 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list