Anthem Blue Cross and Blue Shield Nevada policy
Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver
Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver is a public Anthem Blue Cross and Blue Shield Nevada policy (policy CG-SURG-61). It lists 25 CPT or HCPCS codes, 19 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-61
- 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 |
|---|---|---|---|
| 0581T | On the list | Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, unilateral | Policies naming 0581T |
| 0673T | On the list | Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance | Policies naming 0673T |
| 0970T | On the list | Ablation, benign breast tumor (eg, fibroadenoma), percutaneous, laser, including imaging guidance when performed, each tumor | Policies naming 0970T |
| 0971T | On the list | Ablation, malignant breast tumor(s), percutaneous, laser, including imaging guidance when performed, unilateral | Policies naming 0971T |
| 19105 | On the list | Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma | Policies naming 19105 |
| 19499 | Not listed | Policies naming 19499 | |
| 20982 | On the list | Ablation, Bone Tumor(s) Radiofrequency, Percutaneous, Including Computed Tomographic Guidance | Policies naming 20982 |
| 20983 | On the list | Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, includin | Policies naming 20983 |
| 20999 | Not listed | Policies naming 20999 | |
| 32994 | On the list | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Policies naming 32994 |
| 32998 | On the list | Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging | Policies naming 32998 |
| 32999 | Not listed | Policies naming 32999 | |
| 48999 | Not listed | Policies naming 48999 | |
| 50250 | On the list | Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed | Policies naming 50250 |
| 50542 | On the list | Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed | Policies naming 50542 |
| 50592 | On the list | Ablation, 1 or more renal tumor(s), percutaneous, unilateral, radiofrequency | Policies naming 50592 |
| 50593 | On the list | Ablation, renal tumor(s), unilateral, presutaneous cryotherapy | Policies naming 50593 |
| 53850 | On the list | Transurethral Destruction, Prostate Tissue; Microwave Thermotherapy | Policies naming 53850 |
| 53852 | On the list | Transurethral Destruction, Prostate Tissue; Radiofrequency Thermotherapy | Policies naming 53852 |
| 55873 | On the list | Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring) | Policies naming 55873 |
| 60660 | On the list | Percutaneous ablation of 1 or more thyroid nodule(s) | Policies naming 60660 |
| 60661 | Not listed | Policies naming 60661 | |
| 60699 | Not listed | Policies naming 60699 | |
| 61736 | On the list | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 si | Policies naming 61736 |
| 61737 | On the list | Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for | Policies naming 61737 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list