Blue Cross and Blue Shield of Illinois policy
Prolotherapy
Prolotherapy is a public Blue Cross and Blue Shield of Illinois policy (policy MED201.013, effective Jun 15, 2025). It lists 5 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Policy number
- MED201.013
- Effective
- Jun 15, 2025
- Line of business
- Commercial, Medicaid
- Source
- medicalpolicy.hcsc.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Blue Cross and Blue Shield of Illinois policies |
|---|---|
| 20550 | Policies naming 20550 |
| 20551 | Policies naming 20551 |
| 20552 | Policies naming 20552 |
| 20999 | Policies naming 20999 |
| M0076 | Policies naming M0076 |