Anthem Blue Cross and Blue Shield New Hampshire policy
SURG.00155 Cryosurgery of Peripheral Nerves
SURG.00155 Cryosurgery of Peripheral Nerves is a public Anthem Blue Cross and Blue Shield New Hampshire policy (policy SURG.00155). It lists 8 CPT or HCPCS codes, 7 of them on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage decision; the payer's own document governs.
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- Policy number
- SURG.00155
- 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 New Hampshire prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield New Hampshire policies |
|---|---|---|---|
| 0440T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0440T |
| 0441T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0441T |
| 0442T | On the list | Ablation, percutaneous, cryoablation, inclu | Policies naming 0442T |
| 64624 | On the list | Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed | Policies naming 64624 |
| 64640 | On the list | Destruction by neurolytic agent; other peripheral nerve or branch | Policies naming 64640 |
| 64999 | Not listed | Policies naming 64999 | |
| C9808 | On the list | Nerve cryoablation probe (e.g., cryoICE, cryoSPHERE, cryoSPHERE MAX, cryo2), including probe and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023) | Policies naming C9808 |
| C9809 | On the list | Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023) | Policies naming C9809 |
All Anthem Blue Cross and Blue Shield New Hampshire policies · Anthem Blue Cross and Blue Shield New Hampshire prior authorization CPT list