Anthem Blue Cross and Blue Shield Nevada policy
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches
SURG.00096 Surgical and Ablative Treatments for Chronic Headaches is a public Anthem Blue Cross and Blue Shield Nevada policy (policy SURG.00096). It lists 18 CPT or HCPCS codes, 16 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
- SURG.00096
- 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 |
|---|---|---|---|
| 14040 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet; 10 Sq Cm/< | Policies naming 14040 |
| 14041 | On the list | Adjacent Tissue Transfer, Forehead/Cheeks/Chin/Mouth/Neck/Axillae/Genitalia/Hands/Feet;10.1- 30.0sqcm | Policies naming 14041 |
| 14060 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10 Sq Cm/< | Policies naming 14060 |
| 14061 | On the list | Adjacent Tissue Transfer/Rearrangement, Eyelids/Nose/Ears/Lips; Defect 10.1- 30.0 Sq Cm | Policies naming 14061 |
| 15824 | On the list | Rhytidectomy; Forehead | Policies naming 15824 |
| 15826 | On the list | Rhytidectomy; Glabellar Frown Lines | Policies naming 15826 |
| 64640 | On the list | Destruction, Neurolytic; Other Peripheral Nerve/Branch | Policies naming 64640 |
| 64716 | On the list | Neuroplasty &/Or Transposition; Cranial Nerve (Specify) | Policies naming 64716 |
| 64722 | On the list | Decompression; Unspecified Nerve(S) (Specify) | Policies naming 64722 |
| 64732 | On the list | Transection/Avulsion; Supraorbital Nerve | Policies naming 64732 |
| 64734 | On the list | Transection/Avulsion; Infraorbital Nerve | Policies naming 64734 |
| 64744 | On the list | Transection/Avulsion; Greater Occipital Nerve | Policies naming 64744 |
| 64771 | On the list | Transection/Avulsion, Other Cranial Nerve, Extradural | Policies naming 64771 |
| 64772 | On the list | Transection/Avulsion, Other Spinal Nerve, Extradural | Policies naming 64772 |
| 64787 | Not listed | Policies naming 64787 | |
| 64999 | Not listed | Policies naming 64999 | |
| 67900 | On the list | Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach) | Policies naming 67900 |
| 93580 | On the list | Perc Transcatheter Closure, Congenital Interatrial Communication W/Implant | Policies naming 93580 |
All Anthem Blue Cross and Blue Shield Nevada policies · Anthem Blue Cross and Blue Shield Nevada prior authorization CPT list