Anthem Blue Cross Blue Shield of Georgia policy
TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products
TRANS.00035 Therapeutic use of Stem Cells, Blood and Bone Marrow Products is a public Anthem Blue Cross Blue Shield of Georgia policy (policy TRANS.00035). It lists 27 CPT or HCPCS codes, 17 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
- TRANS.00035
- 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 |
|---|---|---|---|
| 00011 | Not listed | Policies naming 00011 | |
| 00035 | Not listed | Policies naming 00035 | |
| 00110 | Not listed | Policies naming 00110 | |
| 00132 | Not listed | Policies naming 00132 | |
| 00155 | Not listed | Policies naming 00155 | |
| 0232T | On the list | Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed | Policies naming 0232T |
| 0263T | On the list | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete pro | Policies naming 0263T |
| 0264T | On the list | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete pro | Policies naming 0264T |
| 0265T | On the list | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; unilateral o | Policies naming 0265T |
| 0481T | On the list | Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed | Policies naming 0481T |
| 0748T | On the list | Injections of stem cell product into perianal perifistular soft tissue, including fistula preparation (eg, removal of setons, fistula curettage, closure of internal openings) | Policies naming 0748T |
| 1092T | Not listed | Policies naming 1092T | |
| 1093T | Not listed | Policies naming 1093T | |
| 1094T | Not listed | Policies naming 1094T | |
| 1095T | Not listed | Policies naming 1095T | |
| 17999 | On the list | Unlisted procedure, skin, mucous membrane and subcutaneous tissue | Policies naming 17999 |
| 20999 | On the list | Unlisted procedure, musculoskeletal system, general | Policies naming 20999 |
| 33999 | On the list | Unlisted procedure, cardiac surgery | Policies naming 33999 |
| 38205 | On the list | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; allogeneic | Policies naming 38205 |
| 38206 | On the list | Blood-Derived Hematopoietic Progenitor Cell Harvesting, Transplantation/Collection; Autologous | Policies naming 38206 |
| 38230 | On the list | Bone marrow harvesting for transplantation; allogeneic | Policies naming 38230 |
| 38232 | On the list | Bone Marrow Harvesting For Transplantation; Autologous | Policies naming 38232 |
| 38999 | On the list | Unlisted procedure, hemic or lymphatic system | Policies naming 38999 |
| 64999 | On the list | Unlisted procedure, nervous system | Policies naming 64999 |
| G0460 | On the list | Autologous platelet rich plasma (PRP) or other blood-derived product for nondiabetic chronic wounds/ulcers (includes, as applicable: administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment) | Policies naming G0460 |
| G0465 | On the list | Autologous platelet rich plasma (PRP) or other blood-derived product for diabetic chronic wounds/ulcers, using an FDA-cleared device for this indication, (includes, as applicable: administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment) | Policies naming G0465 |
| P9020 | Not listed | Policies naming P9020 |
All Anthem Blue Cross Blue Shield of Georgia policies · Anthem Blue Cross Blue Shield of Georgia prior authorization CPT list