Anthem Blue Cross and Blue Shield Nevada policy
Bundled Services and Supplies - Facility
Bundled Services and Supplies - Facility is a public Anthem Blue Cross and Blue Shield Nevada policy (policy C-23001, effective Jun 1, 2026). It lists 46 CPT or HCPCS codes, 8 of them on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
- Policy number
- C-23001
- Effective
- Jun 1, 2026
- Line of business
- Commercial
- States
- CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI
- 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 and Blue Shield Nevada prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Nevada policies |
|---|---|---|---|
| 15851 | Not listed | Policies naming 15851 | |
| 76014 | Not listed | Policies naming 76014 | |
| 76019 | Not listed | Policies naming 76019 | |
| 76979 | Not listed | Policies naming 76979 | |
| 76983 | Not listed | Policies naming 76983 | |
| 77293 | Not listed | Policies naming 77293 | |
| 77387 | On the list | Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed | Policies naming 77387 |
| 87913 | Not listed | Policies naming 87913 | |
| 94760 | Not listed | Policies naming 94760 | |
| 94762 | Not listed | Policies naming 94762 | |
| 96521 | Not listed | Policies naming 96521 | |
| 96522 | Not listed | Policies naming 96522 | |
| 96523 | Not listed | Policies naming 96523 | |
| 97010 | On the list | Application of a modality to 1 or more areas; hot or cold packs | Policies naming 97010 |
| 99070 | Not listed | Policies naming 99070 | |
| 99190 | Not listed | Policies naming 99190 | |
| 99192 | Not listed | Policies naming 99192 | |
| A4206 | Not listed | Policies naming A4206 | |
| A4262 | Not listed | Policies naming A4262 | |
| A4265 | Not listed | Policies naming A4265 | |
| A9300 | Not listed | Policies naming A9300 | |
| A9900 | Not listed | Policies naming A9900 | |
| A9901 | Not listed | Policies naming A9901 | |
| A9999 | Not listed | Policies naming A9999 | |
| B9004 | On the list | Parenteral Infus Pump Portab | Policies naming B9004 |
| B9006 | On the list | Parenteral Infus Pump Statio | Policies naming B9006 |
| B9999 | Not listed | Policies naming B9999 | |
| C1714 | Not listed | Policies naming C1714 | |
| C1724 | Not listed | Policies naming C1724 | |
| C1725 | Not listed | Policies naming C1725 | |
| C1734 | On the list | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) | Policies naming C1734 |
| C1753 | Not listed | Policies naming C1753 | |
| C1762 | Not listed | Policies naming C1762 | |
| C1763 | On the list | Connective tissue, nonhuman (includes synthetic) | Policies naming C1763 |
| C1769 | Not listed | Policies naming C1769 | |
| C1781 | Not listed | Policies naming C1781 | |
| C1885 | Not listed | Policies naming C1885 | |
| C1887 | Not listed | Policies naming C1887 | |
| C1889 | Not listed | Policies naming C1889 | |
| C9359 | On the list | Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Putty, Integra OS Osteoconductive Scaffold Putty), per 0.5 cc | Policies naming C9359 |
| C9362 | On the list | Porous purified collagen matrix bone void filler (Integra Mozaik Osteoconductive Scaffold Strip), per 0.5 cc | Policies naming C9362 |
| G0498 | Not listed | Policies naming G0498 | |
| G2211 | Not listed | Policies naming G2211 | |
| K1034 | Not listed | Policies naming K1034 | |
| L8699 | Not listed | Policies naming L8699 | |
| T1040 | Not listed | Policies naming T1040 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list