Blue Cross and Blue Shield of Texas policy
Prolotherapy
Prolotherapy is a public Blue Cross and Blue Shield of Texas 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.
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- 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. Open official prior authorization lists to check the member’s product.
| Code | Other Blue Cross and Blue Shield of Texas policies |
|---|---|
| 20550 | Policies naming 20550 |
| 20551 | Policies naming 20551 |
| 20552 | Policies naming 20552 |
| 20999 | Policies naming 20999 |
| M0076 | Policies naming M0076 |
All Blue Cross and Blue Shield of Texas policies · Blue Cross and Blue Shield of Texas prior authorization CPT list