Anthem Blue Cross Blue Shield of California policy
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00096). It lists 18 CPT or HCPCS codes, 18 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
- SURG.00096
- 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 |
|---|---|---|---|
| 14040 | On the list | Adjacent tissue transfer or rearrangement, forehead, cheeks chin, mouth, neck, axillae, genitalia, hands and/or feet | Policies naming 14040 |
| 14041 | On the list | Adjacent tissue transfer or rearrangement, forehead, cheeks chin, mouth, neck, axillae, genitalia, hands and/or feet | Policies naming 14041 |
| 14060 | On the list | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips | Policies naming 14060 |
| 14061 | On the list | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips | Policies naming 14061 |
| 15824 | On the list | Rhytidectomy; forehead | Policies naming 15824 |
| 15826 | On the list | Rhytidectomy; glabellar frown lines | Policies naming 15826 |
| 64640 | On the list | Destruction by neurolytic agent; other peripheral nerve or branch | Policies naming 64640 |
| 64716 | On the list | Neuroplasty and/or transposition; cranial nerve (specify) | Policies naming 64716 |
| 64722 | On the list | Decompression; unspecified nerve(s) [for example, occipital nerve] | Policies naming 64722 |
| 64732 | On the list | Transection or avulsion of; supraorbital nerve | Policies naming 64732 |
| 64734 | On the list | Transection or avulsion of; infraorbital nerve | Policies naming 64734 |
| 64744 | On the list | Transection or avulsion of; greater occipital nerve | Policies naming 64744 |
| 64771 | On the list | Transection or avulsion of other cranial nerve, extradural | Policies naming 64771 |
| 64772 | On the list | Transection or avulsion of other spinal nerve, extradural | Policies naming 64772 |
| 64787 | On the list | Implantation of nerve end into bone or muscle | Policies naming 64787 |
| 64999 | On the list | Unlisted procedure, nervous system [when specified as implantation, revision, replacement, or removal of vagus nerve blocking neurostimulator electrode array or pulse generator at the esophagogastric junction] or [when specified as percutaneous neuromodulation therapy] or [when specified as introduction of Kebilidi into cranial cavity and brain] or [when specified as craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebellar] or [when specified as percutaneous decompression or laser procedures of cervical or thoracic spine] or [when specified as epiduroscopy] or [when specified as pulsed radiofrequency treatment] or [when specified as cooled or pulsed RF therapy (not destruction) to genicular nerve(s)] or [when specified as cryoneurolysis] or [when specified as nanoparticle thermal ablation] or [when specified as adrenal tissue, fetal mesencephalic tissue or fetal xenograft tissue transplant to brain] or [when specified as harvesting or administration of stem cells for therapy to repair damaged cells or body tissues] | Policies naming 64999 |
| 67900 | On the list | Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) | Policies naming 67900 |
| 93580 | On the list | Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrial septal defect) with implant | Policies naming 93580 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list