Optimum Healthcare policy

SHBP Medical Policies & Clinical Guidelines Precertification Code List

SHBP Medical Policies & Clinical Guidelines Precertification Code List is a public Optimum Healthcare policy (effective Jan 1, 2022). It lists 2,220 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy (PDF) ↗

Payer
Optimum Healthcare
Effective
Jan 1, 2022
Line of business
Commercial
States
GA
Source
www.anthem.com

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther Optimum Healthcare policies
00003Policies naming 00003
00004Policies naming 00004
00005Policies naming 00005
00007Policies naming 00007
00008Policies naming 00008
00009Policies naming 00009
00010Policies naming 00010
00011Policies naming 00011
00013Policies naming 00013
00017Policies naming 00017
00022Policies naming 00022
00023Policies naming 00023
00024Policies naming 00024
00025Policies naming 00025
00026Policies naming 00026
00027Policies naming 00027
00028Policies naming 00028
00029Policies naming 00029
00030Policies naming 00030
00031Policies naming 00031
00032Policies naming 00032
00033Policies naming 00033
00034Policies naming 00034
00035Policies naming 00035
00037Policies naming 00037
00039Policies naming 00039
00042Policies naming 00042
00047Policies naming 00047
00052Policies naming 00052
00053Policies naming 00053
00057Policies naming 00057
00059Policies naming 00059
00061Policies naming 00061
00062Policies naming 00062
00070Policies naming 00070
00071Policies naming 00071
00072Policies naming 00072
00082Policies naming 00082
00089Policies naming 00089
00090Policies naming 00090
00092Policies naming 00092
00095Policies naming 00095
00096Policies naming 00096
00098Policies naming 00098
00103Policies naming 00103
00104Policies naming 00104
00107Policies naming 00107
00111Policies naming 00111
00115Policies naming 00115
00118Policies naming 00118
00120Policies naming 00120
00121Policies naming 00121
00123Policies naming 00123
00129Policies naming 00129
00131Policies naming 00131
00141Policies naming 00141
00143Policies naming 00143
00145Policies naming 00145
00150Policies naming 00150
00158Policies naming 00158
0016UPolicies naming 0016U
0017UPolicies naming 0017U
0023UPolicies naming 0023U
0027UPolicies naming 0027U
0040UPolicies naming 0040U
0045UPolicies naming 0045U
0046UPolicies naming 0046U
0049UPolicies naming 0049U
00530Policies naming 00530
00534Policies naming 00534
0054TPolicies naming 0054T
0055TPolicies naming 0055T
00580Policies naming 00580
0071TPolicies naming 0071T
0072TPolicies naming 0072T
0075TPolicies naming 0075T
0076TPolicies naming 0076T
00796Policies naming 00796
00797Policies naming 00797
00802Policies naming 00802
0095TPolicies naming 0095T
0098TPolicies naming 0098T
0111UPolicies naming 0111U
0153UPolicies naming 0153U
0154UPolicies naming 0154U
0155UPolicies naming 0155U
0163TPolicies naming 0163T
0164TPolicies naming 0164T
0165TPolicies naming 0165T
0177UPolicies naming 0177U
0200TPolicies naming 0200T
0201TPolicies naming 0201T
0202TPolicies naming 0202T
0209UPolicies naming 0209U
0213TPolicies naming 0213T
0214TPolicies naming 0214T
0215TPolicies naming 0215T
0216TPolicies naming 0216T
0217TPolicies naming 0217T
0218TPolicies naming 0218T
0228TPolicies naming 0228T
0229TPolicies naming 0229T
0229UPolicies naming 0229U
0230TPolicies naming 0230T
0231TPolicies naming 0231T
0235UPolicies naming 0235U
0253TPolicies naming 0253T
0263TPolicies naming 0263T
0264TPolicies naming 0264T
0265TPolicies naming 0265T
0274TPolicies naming 0274T
0275TPolicies naming 0275T
0312TPolicies naming 0312T
0313TPolicies naming 0313T
0314TPolicies naming 0314T
0315TPolicies naming 0315T
0316TPolicies naming 0316T
0317TPolicies naming 0317T
0318UPolicies naming 0318U
0335TPolicies naming 0335T
0342TPolicies naming 0342T
0345TPolicies naming 0345T
0355TPolicies naming 0355T
0398TPolicies naming 0398T
0402TPolicies naming 0402T
0421TPolicies naming 0421T
0424TPolicies naming 0424T
0425TPolicies naming 0425T
0426TPolicies naming 0426T
0427TPolicies naming 0427T
0428TPolicies naming 0428T
0429TPolicies naming 0429T
0430TPolicies naming 0430T
0431TPolicies naming 0431T
0432TPolicies naming 0432T
0433TPolicies naming 0433T
0434TPolicies naming 0434T
0435TPolicies naming 0435T
0436TPolicies naming 0436T
0449TPolicies naming 0449T
0450TPolicies naming 0450T
0468TPolicies naming 0468T
0474TPolicies naming 0474T
0483TPolicies naming 0483T
0484TPolicies naming 0484T
0494TPolicies naming 0494T
0495TPolicies naming 0495T
0496TPolicies naming 0496T
0501TPolicies naming 0501T
0502TPolicies naming 0502T
0503TPolicies naming 0503T
0504TPolicies naming 0504T
0505TPolicies naming 0505T
0510TPolicies naming 0510T
0511TPolicies naming 0511T
0524TPolicies naming 0524T
0537TPolicies naming 0537T
0538TPolicies naming 0538T
0539TPolicies naming 0539T
0540TPolicies naming 0540T
0544TPolicies naming 0544T
0545TPolicies naming 0545T
0569TPolicies naming 0569T
0570TPolicies naming 0570T
0581TPolicies naming 0581T
0584TPolicies naming 0584T
0585TPolicies naming 0585T
0586TPolicies naming 0586T
0587TPolicies naming 0587T
0588TPolicies naming 0588T
0589TPolicies naming 0589T
0590TPolicies naming 0590T
0596TPolicies naming 0596T
0597TPolicies naming 0597T
0620TPolicies naming 0620T
0627TPolicies naming 0627T
0628TPolicies naming 0628T
0629TPolicies naming 0629T
0630TPolicies naming 0630T
0672TPolicies naming 0672T
0686TPolicies naming 0686T
1108GPolicies naming 1108G
1118APolicies naming 1118A
11920Policies naming 11920
11921Policies naming 11921
11922Policies naming 11922
11950Policies naming 11950
11951Policies naming 11951
11952Policies naming 11952
11954Policies naming 11954
14041Policies naming 14041
14060Policies naming 14060
14061Policies naming 14061
15150Policies naming 15150
15151Policies naming 15151
15152Policies naming 15152
15155Policies naming 15155
15156Policies naming 15156
15157Policies naming 15157
15271Policies naming 15271
15272Policies naming 15272
15273Policies naming 15273
15274Policies naming 15274
15275Policies naming 15275
15276Policies naming 15276
15277Policies naming 15277
15278Policies naming 15278
15775Policies naming 15775
15776Policies naming 15776
15777Policies naming 15777
15780Policies naming 15780
15781Policies naming 15781
15782Policies naming 15782
15783Policies naming 15783
15786Policies naming 15786
15787Policies naming 15787
15788Policies naming 15788
15789Policies naming 15789
15792Policies naming 15792
15793Policies naming 15793
15819Policies naming 15819
15820Policies naming 15820
15821Policies naming 15821
15822Policies naming 15822
15823Policies naming 15823
15824Policies naming 15824
15825Policies naming 15825
15826Policies naming 15826
15828Policies naming 15828
15829Policies naming 15829
15830Policies naming 15830
15832Policies naming 15832
15833Policies naming 15833
15834Policies naming 15834
15835Policies naming 15835
15836Policies naming 15836
15837Policies naming 15837
15838Policies naming 15838
15839Policies naming 15839
15840Policies naming 15840
15841Policies naming 15841
15842Policies naming 15842
15843Policies naming 15843
15844Policies naming 15844
15845Policies naming 15845
15847Policies naming 15847
15876Policies naming 15876
15877Policies naming 15877
15878Policies naming 15878
15879Policies naming 15879
1635GPolicies naming 1635G
17106Policies naming 17106
17107Policies naming 17107
17108Policies naming 17108
17380Policies naming 17380
17999Policies naming 17999
19105Policies naming 19105
19316Policies naming 19316
19318Policies naming 19318
19325Policies naming 19325
19328Policies naming 19328
19330Policies naming 19330
19340Policies naming 19340
19342Policies naming 19342
19350Policies naming 19350
19355Policies naming 19355
19357Policies naming 19357
19361Policies naming 19361
19364Policies naming 19364
19367Policies naming 19367
19368Policies naming 19368
19369Policies naming 19369
19380Policies naming 19380
19396Policies naming 19396
20605Policies naming 20605
20606Policies naming 20606
20930Policies naming 20930
20931Policies naming 20931
20932Policies naming 20932
20933Policies naming 20933
20934Policies naming 20934
20936Policies naming 20936
20937Policies naming 20937
20938Policies naming 20938
20939Policies naming 20939
20974Policies naming 20974
20979Policies naming 20979
20982Policies naming 20982
20983Policies naming 20983
20985Policies naming 20985
20999Policies naming 20999
21010Policies naming 21010
21050Policies naming 21050
21060Policies naming 21060
21073Policies naming 21073
21083Policies naming 21083
21087Policies naming 21087
21110Policies naming 21110
21116Policies naming 21116
21120Policies naming 21120

And 1,920 more in the original policy.

All Optimum Healthcare policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.