Anthem Blue Cross Blue Shield of Georgia policy
SURG.00045 Extracorporeal Shock Wave Therapy
SURG.00045 Extracorporeal Shock Wave Therapy is a public Anthem Blue Cross Blue Shield of Georgia policy (policy SURG.00045). It lists 6 CPT or HCPCS codes, 5 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
- SURG.00045
- 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 |
|---|---|---|---|
| 0101T | On the list | Extracorporeal shock wave involving musculoskeletal system, not otherwise specified, high energy | Policies naming 0101T |
| 0102T | On the list | Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, involving lateral humeral epicondyle | Policies naming 0102T |
| 0512T | On the list | Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound | Policies naming 0512T |
| 0513T | Not listed | Policies naming 0513T | |
| 0864T | On the list | Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy | Policies naming 0864T |
| 28890 | On the list | Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia | Policies naming 28890 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list