Anthem Blue Cross and Blue Shield Nevada policy
CG-SURG-01 Colonoscopy
CG-SURG-01 Colonoscopy is a public Anthem Blue Cross and Blue Shield Nevada policy (policy CG-SURG-01). It lists 22 CPT or HCPCS codes, 13 of them on the Anthem Blue Cross and Blue Shield Nevada prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- CG-SURG-01
- 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 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 |
|---|---|---|---|
| 44388 | On the list | Colonoscopy Through Stoma; Dx W/Wo Specimens, Brushing/Washing (Sep Proc) | Policies naming 44388 |
| 44389 | On the list | Colonoscopy Through Stoma; W/Bx, Single/Multiple | Policies naming 44389 |
| 44390 | Not listed | Policies naming 44390 | |
| 44391 | Not listed | Policies naming 44391 | |
| 44392 | On the list | Colonoscopy Through Stoma; W/Removal, Lesion, Hot Forceps/Cautery | Policies naming 44392 |
| 44394 | On the list | Colonoscopy Through Stoma; W/Removal, Lesion, Snare | Policies naming 44394 |
| 44401 | Not listed | Policies naming 44401 | |
| 44402 | Not listed | Policies naming 44402 | |
| 44404 | Not listed | Policies naming 44404 | |
| 44405 | Not listed | Policies naming 44405 | |
| 45378 | On the list | Colonoscopy, Flexible, Proximal To Splenic Flexure; Dx, W/Wo Specimens/Colon Decomp (Sep Proc) | Policies naming 45378 |
| 45379 | On the list | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Removal, Fb | Policies naming 45379 |
| 45380 | On the list | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Bx, Single/Multiple | Policies naming 45380 |
| 45381 | On the list | Colonoscpy, Flexible, Proximal To Splenic Flexure; W/Directed Submucosa Injection(S), Any Substance | Policies naming 45381 |
| 45382 | Not listed | Policies naming 45382 | |
| 45384 | On the list | Colonoscopy, Flexible; W/Removal, Lesion, Hot Forceps/Cautery | Policies naming 45384 |
| 45385 | On the list | Colonoscopy, Flexible; W/Removal, Lesion, Snare | Policies naming 45385 |
| 45386 | On the list | Colonoscopy, Flexible, Proximal To Splenic Flexure; W/Dilation, Balloon, 1/> Strictures | Policies naming 45386 |
| 45388 | On the list | Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) | Policies naming 45388 |
| 45389 | On the list | Colonoscopy, flexible; with endoscopic stent placement (includes pre- and post- dilation and guide wire passage, when performed) | Policies naming 45389 |
| G0105 | Not listed | Policies naming G0105 | |
| G0121 | Not listed | Policies naming G0121 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list