Anthem Blue Cross Blue Shield of Georgia policy
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices is a public Anthem Blue Cross Blue Shield of Georgia policy (policy DME.00011). It lists 15 CPT or HCPCS codes, 14 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
- DME.00011
- 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 |
|---|---|---|---|
| 0278T | On the list | Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes) | Policies naming 0278T |
| 0766T | On the list | Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, with identification and mapping of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; first nerve | Policies naming 0766T |
| 0767T | On the list | Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse, peripheral nerve, with identification and mapping of the treatment location, including noninvasive electroneurographic localization (nerve conduction localization), when performed; each additional nerve (List separately in addition to code for primary procedure) | Policies naming 0767T |
| 1088T | Not listed | Policies naming 1088T | |
| 64999 | On the list | Unlisted procedure, nervous system | Policies naming 64999 |
| A4596 | On the list | Cranial electrotherapy stimulation (ces) system supplies and accessories, per month | Policies naming A4596 |
| E0732 | On the list | Cranial electrotherapy stimulation (CES) system, any type | Policies naming E0732 |
| E0761 | On the list | Nonthermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device | Policies naming E0761 |
| E0762 | On the list | Transcutaneous electrical joint stimulation device system, includes all accessories | Policies naming E0762 |
| E0765 | On the list | FDA-approved nerve stimulator, for treatment of nausea and vomiting | Policies naming E0765 |
| E0769 | On the list | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified | Policies naming E0769 |
| E1399 | On the list | Durable medical equipment, miscellaneous | Policies naming E1399 |
| S8130 | On the list | Interferential current stimulator, 2 channel | Policies naming S8130 |
| S8131 | On the list | Interferential current stimulator, 4 channel | Policies naming S8131 |
| S8930 | On the list | Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with patient | Policies naming S8930 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list