Anthem Blue Cross Blue Shield of Georgia policy
CG-SURG-79 Implantable Infusion Pumps
CG-SURG-79 Implantable Infusion Pumps is a public Anthem Blue Cross Blue Shield of Georgia policy (policy CG-SURG-79). It lists 18 CPT or HCPCS codes, 15 of them on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-SURG-79
- 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 Georgia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of Georgia policies |
|---|---|---|---|
| 36260 | On the list | Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of liver) | Policies naming 36260 |
| 36261 | On the list | Revision of implanted intra-arterial infusion pump | Policies naming 36261 |
| 36262 | Not listed | Policies naming 36262 | |
| 36563 | On the list | Insertion of tunneled centrally inserted central venous access device with subcutaneous pump | Policies naming 36563 |
| 36583 | On the list | Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access | Policies naming 36583 |
| 61215 | On the list | Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter | Policies naming 61215 |
| 62350 | On the list | Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy | Policies naming 62350 |
| 62351 | On the list | Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy | Policies naming 62351 |
| 62360 | On the list | Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir | Policies naming 62360 |
| 62361 | On the list | Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump | Policies naming 62361 |
| 62362 | On the list | Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming | Policies naming 62362 |
| 62365 | Not listed | Policies naming 62365 | |
| C1772 | On the list | Infusion pump, programmable (implantable) | Policies naming C1772 |
| C1891 | Not listed | Policies naming C1891 | |
| C2626 | On the list | Infusion pump, nonprogrammable, temporary (implantable) | Policies naming C2626 |
| E0782 | On the list | Non-Programble Infusion Pump | Policies naming E0782 |
| E0783 | On the list | Programmable Infusion Pump | Policies naming E0783 |
| E0786 | On the list | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) | Policies naming E0786 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list