Anthem Blue Cross Blue Shield of California policy
SURG.00162 Implantable Shock Absorber for Treatment of Knee Osteoarthritis
SURG.00162 Implantable Shock Absorber for Treatment of Knee Osteoarthritis is a public Anthem Blue Cross Blue Shield of California policy (policy SURG.00162). It lists 4 CPT or HCPCS codes, 4 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.00162
- 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 |
|---|---|---|---|
| 27599 | On the list | Unlisted procedure, femur or knee [when specified as implantation of a medial knee implanted shock absorber] or [when specified as implantation of RETHYMIC into quadriceps muscle] | Policies naming 27599 |
| A4649 | On the list | Surgical supply, miscellaneous [no specific code for antimicrobial silver wound dressings (e.g., Acticoat, Actisorb, AQUACEL Ag, Promogran Prisma, Silversorb, Urgotul Silver)] or [when specified as supply of a medial knee implanted shock absorber] | Policies naming A4649 |
| C1734 | On the list | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to-bone (implantable) | Policies naming C1734 |
| C8003 | On the list | Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy) | Policies naming C8003 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list