Anthem Blue Cross Blue Shield of California policy
Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions
Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions is a public Anthem Blue Cross Blue Shield of California policy (policy LAB.00026). It lists 5 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
- LAB.00026
- 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 |
|---|---|---|---|
| 0108U | On the list | Gastroenterology (Barrett’s esophagus), whole slide-digital imaging, including morphometric analysis, computer-assisted quantitative immunolabeling of 9 protein biomarkers (p16, AMACR, p53, CD68, COX-2, CD45RO, HIF1a, HER-2, K20) and morphology, formalin-fixed paraffin-embedded tissue, algorithm reported as risk of progression to high-grade dysplasia or cancer | Policies naming 0108U |
| 0376U | On the list | Oncology (prostate cancer), image analysis of at least 128 histologic features and clinical factors, prognostic algorithm determining the risk of distant metastases, and prostate cancer-specific mortality, includes predictive algorithm to androgen deprivation-therapy response, if appropriate | Policies naming 0376U |
| 1106T | Not listed | Policies naming 1106T | |
| 1107T | On the list | Oncology (prostate), augmentative algorithmic analysis of histomorphologic features in digitized hematoxylin and eosin stained slide(s) from formalin-fixed paraffin-embedded (FFPE) prostate cancer tissue, algorithm-derived parameters reported as 10-year risk of distant metastasis and prostate cancer specific mortality, including hematoxylin and eosin staining of tissue sections, and digitization of glass microscope slides, when performed [ArteraAI Prostate test algorithm] | Policies naming 1107T |
| 88399 | On the list | Unlisted surgical pathology procedure [when specified as use of an AI-based software product for cytopathologic prostate cancer detection] | Policies naming 88399 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list