Anthem Blue Cross Blue Shield of California policy
MED.00132 Autologous Adipose-derived Regenerative Cell Therapy
MED.00132 Autologous Adipose-derived Regenerative Cell Therapy is a public Anthem Blue Cross Blue Shield of California policy (policy MED.00132). It lists 8 CPT or HCPCS codes, 8 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
Check eligibility for free
No account required. Sign a BAA to see plan details, coordination of benefits and more
- Policy number
- MED.00132
- 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 |
|---|---|---|---|
| 0489T | On the list | Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; adipose tissue harvesting, isolation and preparation of harvested cells including incubation with cell dissociation enzymes, removal of non-viable cells and debris, determination of concentration and dilution of regenerative cells | Policies naming 0489T |
| 0490T | On the list | Autologous adipose-derived regenerative cell therapy for scleroderma in the hands; multiple injections in one or both hands | Policies naming 0490T |
| 0565T | On the list | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation | Policies naming 0565T |
| 0566T | On the list | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral | Policies naming 0566T |
| 0717T | On the list | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing and concentration of ADRCs | Policies naming 0717T |
| 0718T | On the list | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; injection into supraspinatus tendon including ultrasound guidance, unilateral | Policies naming 0718T |
| 46999 | On the list | Unlisted procedure, anus [when specified as perianal injection of autologous adipose-derived regenerative cells, e.g., for fistulizing Crohn’s disease] or [when specified as delivery of thermal energy to the muscle of the anal canal (e.g., for fecal incontinence)] or [when specified as anal sphincteroplasty for incontinence with implantation of an artificial sphincter] | Policies naming 46999 |
| 55899 | On the list | Unlisted procedure, male genital system [when specified as phalloplasty] or [when specified as image-guided focused ultrasound ablation of prostate tissue for non-oncologic indications, such as benign prostatic hyperplasia] or [when specified as intracavernous injection of autologous adipose- derived regenerative cells, e.g., for erectile dysfunction] or [when specified as nanoparticle thermal ablation] or [when specified as histotripsy of prostate tissue] | Policies naming 55899 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list