Anthem Blue Cross Blue Shield of California policy
THER-RAD.00012 Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation
THER-RAD.00012 Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation is a public Anthem Blue Cross Blue Shield of California policy (policy THER-RAD.00012). It lists 3 CPT or HCPCS codes, 3 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
- THER-RAD.00012
- 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 |
|---|---|---|---|
| 0745T | On the list | Cardiac focal ablation utilizing radiation therapy for arrhythmia; noninvasive arrhythmia localization and mapping of arrhythmia site (nidus), derived from anatomical image data (e.g., CT, MRI, or myocardial perfusion scan) and electrical data (e.g., 12-lead ECG data), and identification of areas of avoidance | Policies naming 0745T |
| 0746T | On the list | Cardiac focal ablation utilizing radiation therapy for arrhythmia; conversion of arrhythmia localization and mapping of arrhythmia site (nidus) into a multidimensional radiation treatment plan | Policies naming 0746T |
| 0747T | On the list | Cardiac focal ablation utilizing radiation therapy for arrhythmia; delivery of radiation therapy, arrhythmia | Policies naming 0747T |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list