Anthem Blue Cross Blue Shield of Colorado policy
CG-SURG-31 Treatment of Keloids and Scar Revision
CG-SURG-31 Treatment of Keloids and Scar Revision is a public Anthem Blue Cross Blue Shield of Colorado policy (policy CG-SURG-31). It lists 67 CPT or HCPCS codes, 39 of them on the Anthem Blue Cross Blue Shield of Colorado prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-SURG-31
- 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 Colorado prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of Colorado policies |
|---|---|---|---|
| 00007 | Not listed | Policies naming 00007 | |
| 00008 | Not listed | Policies naming 00008 | |
| 00011 | Not listed | Policies naming 00011 | |
| 00110 | Not listed | Policies naming 00110 | |
| 0479T | Not listed | Policies naming 0479T | |
| 0480T | Not listed | Policies naming 0480T | |
| 11400 | Not listed | Policies naming 11400 | |
| 11401 | Not listed | Policies naming 11401 | |
| 11402 | On the list | Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 1.1-2.0 Cm | Policies naming 11402 |
| 11403 | On the list | Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 2.1-3.0 Cm | Policies naming 11403 |
| 11404 | On the list | Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam 3.1-4.0 Cm | Policies naming 11404 |
| 11406 | On the list | Excise, Benign Skin Lesion, Incl Margins, Except Skin Tag, Trunk/Arms/Legs; Excised Diam > 4.0 Cm | Policies naming 11406 |
| 11420 | On the list | Excise Benign Skin Lesion W/Marg, Excpt Skin Tag Scalp/Neck/Hands/Feet/Genital; Excise Diam 0.5cm/< | Policies naming 11420 |
| 11421 | On the list | Excise Ben Skin Lesion W/Marg, Except Skin Tag Scalp/Neck/Hands/Feet/Genital; Excise Diam 0.6-1.0cm | Policies naming 11421 |
| 11422 | On the list | Excise Ben Skin Lesion W/Marg, Except Skin Tag Scalp/Neck/Hands/Feet/Genital; Excise Diam 1.1-2.0cm | Policies naming 11422 |
| 11423 | On the list | Excise Ben Skin Lesion W/Marg, Except Skin Tag Scalp/Neck/Hands/Feet/Genital; Excise Diam 2.1-3.0cm | Policies naming 11423 |
| 11424 | On the list | Excise Ben Skin Lesion W/Marg, Except Skin Tag Scalp/Neck/Hands/Feet/Genital; Excise Diam 3.1-4.0cm | Policies naming 11424 |
| 11426 | On the list | Excise Benign Skin Lesion W/Marg, Except Skin Tag Scalp/Neck/Hands/Ft/Genital; Excise Diam >4.0cm | Policies naming 11426 |
| 11440 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11440 |
| 11441 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11441 |
| 11442 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11442 |
| 11443 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11443 |
| 11444 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11444 |
| 11446 | On the list | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, l | Policies naming 11446 |
| 12031 | On the list | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less | Policies naming 12031 |
| 12032 | On the list | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm | Policies naming 12032 |
| 12034 | On the list | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm | Policies naming 12034 |
| 12035 | On the list | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm | Policies naming 12035 |
| 12036 | Not listed | Policies naming 12036 | |
| 12037 | On the list | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm | Policies naming 12037 |
| 12041 | On the list | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less | Policies naming 12041 |
| 12042 | On the list | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm | Policies naming 12042 |
| 12044 | Not listed | Policies naming 12044 | |
| 12045 | Not listed | Policies naming 12045 | |
| 12046 | Not listed | Policies naming 12046 | |
| 12047 | Not listed | Policies naming 12047 | |
| 12051 | On the list | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | Policies naming 12051 |
| 12052 | On the list | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm | Policies naming 12052 |
| 12053 | Not listed | Policies naming 12053 | |
| 12054 | Not listed | Policies naming 12054 | |
| 12055 | Not listed | Policies naming 12055 | |
| 12056 | Not listed | Policies naming 12056 | |
| 12057 | Not listed | Policies naming 12057 | |
| 13100 | On the list | Repair, Complex, Trunk; 1.1 To 2.5 Cm | Policies naming 13100 |
| 13101 | On the list | Repair, Complex, Trunk; 2.6 To 7.5 Cm | Policies naming 13101 |
| 13102 | Not listed | Policies naming 13102 | |
| 13120 | On the list | Repair, Complex, Scalp, Arms, &/Or Legs; 1.1 To 2.5 Cm | Policies naming 13120 |
| 13121 | On the list | Repair, Complex, Scalp, Arms, &/Or Legs; 2.6 To 7.5 Cm | Policies naming 13121 |
| 13122 | Not listed | Policies naming 13122 | |
| 13131 | On the list | Repair, Complex, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 1.1-2.5 Cm | Policies naming 13131 |
| 13132 | On the list | Repair, Complex, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 2.6-7.5 Cm | Policies naming 13132 |
| 13133 | Not listed | Policies naming 13133 | |
| 13151 | On the list | Repair, Complex, Eyelids, Nose, Ears &/Or Lips; 1.1 To 2.5 Cm | Policies naming 13151 |
| 13152 | On the list | Repair, Complex, Eyelids, Nose, Ears &/Or Lips; 2.6 To 7.5 Cm | Policies naming 13152 |
| 13153 | Not listed | Policies naming 13153 | |
| 14000 | Not listed | Policies naming 14000 | |
| 14001 | Not listed | Policies naming 14001 | |
| 14020 | On the list | Adjacent Tissue Transfer/Rearrangement, Scalp, Arms &/Or Legs; Defect 10 Sq Cm/< | Policies naming 14020 |
| 14021 | Not listed | Policies naming 14021 | |
| 14040 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 10 Sq Cm/< | Policies naming 14040 |
| 14041 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet;10.1-30.0sqcm | Policies naming 14041 |
| 14060 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10 Sq Cm/< | Policies naming 14060 |
| 14061 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10.1- 30.0 Sq Cm | Policies naming 14061 |
| 14301 | On the list | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm | Policies naming 14301 |
| 14302 | Not listed | Policies naming 14302 | |
| 77436 | Not listed | Policies naming 77436 | |
| 77437 | Not listed | Policies naming 77437 |
All Anthem Blue Cross Blue Shield of Colorado policies · Anthem Blue Cross Blue Shield of Colorado prior authorization CPT list